A quality improvement project with relatively simple interventions resulted in a significant decrease in emergency department (ED) visits and inpatient admissions, while saving millions in healthcare costs, according to a study recently published in Pediatrics.
Nationwide Children’s Hospital, Columbus, Ohio, serves almost 3,500 children diagnosed with epilepsy. In 2012 and much of 2013, the ED experienced approximately 17 visits per 1,000 epilepsy patients per month.
Researchers developed a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model. For the study, they determined rates of ED visits as well as unplanned hospitalizations and associated healthcare costs for epilepsy patients. An interdisciplinary QI team was developed for this project. Plan do study act cycles were used with adjustments made when needed.
The QI team identified “key drivers” (or contributing factors) of ED visits, and found they centered on provider-to-provider communication issues and patient/family resources, education, beliefs and comorbidities. Then the team began interventions to target those key drivers.
An important part of the QI project was the establishment of an Urgent Epilepsy Clinic.
“We reserved a few longer clinic appointments which added a nurse practitioner and social worker to appointments for patients and families who exhibited certain ‘red flags,’” says Anup D. Patel, MD, attending pediatric neurologist and director of the Complex Epilepsy Clinic at Nationwide Children's Hospital.
A “red flag” might be an unusual amount of anxiety demonstrated by a parent caregiver, or an exceptionally long time spent on the phone with clinic staffers.