Standardization of seizure response times and data collection in an epilepsy monitoring unit

Intervention time and adverse events in a canadian epilepsy monitoring unit: An updated audit

Background

Optimizing patient safety in the epilepsy monitoring unit (EMU) has become a topic of increasing interest. We performed an audit of our center's new single-floor EMU, assessing intervention rate (IR), intervention time (IT), and adverse events (AEs).

Methods

A prospective study was conducted on all clinical seizures of patients admitted over a one-year period at our Canadian academic tertiary care center's new single-floor EMU. This single-floor EMU was supervised by EEG technologists during daytime (similar to the old set-up) and beneficiary attendants during nighttime/weekends (versus live video feed to the central nursing station on the neurology ward previously). Among 153 admissions, 79 were analyzed, and a total of 537 seizures were reviewed to assess IR, IT, and AEs. Univariate comparisons were performed with our double-floor EMU, which we reported in a previous publication.

Results

In our new single-floor EMU, the IR was 61.1 % and overall median IT was 29.0s (19.0s-45.9s). The AE rate was 4.8 %. Compared to previously reported numbers for our old double-floor EMU (IR = 27.8 %; IT = 21.0s; AE = 1.2 %), the IR was significantly higher ((p < 0.001) but unexpectedly, the median IT was higher (p < 0.001) as well as the AE rate (p < 0.001).

Conclusion

This prospective evaluation revealed a small but non-negligible rate of complications in our EMU, higher than our prior retrospective audit. Heightened levels of supervision in our new single-floor EMU led to higher IR. This may have led to artificially longer ITs.

Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view

OBJECTIVE

We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view.

DESIGN

The study is a survey based feasibility assessment following field testing of QIs for PAAM.

SETTING

The study was performed in two physician staffed emergency medical services in Switzerland.

PARTICIPANTS

42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study.

INTERVENTION

The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF.

RESULTS

Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy.

CONCLUSIONS

Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results.

Epilepsy monitoring unit practices and safety among NAEC epilepsy centers: A census survey

OBJECTIVE

An epilepsy monitoring unit (EMU) is a specialized unit designed for capturing and characterizing seizures and other paroxysmal events with continuous video electroencephalography (vEEG). Nearly 260 epilepsy centers in the United States are accredited by the National Association of Epilepsy Centers (NAEC) based on adherence to specific clinical standards to improve epilepsy care, safety, and quality. This study examines EMU staffing, safety practices, and reported outcomes.

METHOD

We analyzed NAEC annual report data and results from a supplemental survey specific to EMU practices reported in 2019 from 341 pediatric or adult center directors. Data on staffing, resources, safety practices and complications were collated with epilepsy center characteristics. We summarized using frequency (percentage) for categorical variables and median (inter-quartile range) for continuous variables. We used chi-square or Fisher's exact tests to compare staff responsibilities.

RESULTS

The supplemental survey response rate was 100%. Spell classification (39%) and phase 1 testing (28%) were the most common goals of the 91,069 reported admissions. The goal ratio of EEG technologist to beds of 1:4 was the most common during the day (68%) and off-hours (43%). Compared to residents and fellows, advanced practice providers served more roles in the EMU at level 3 or pediatric-only centers. Status epilepticus (SE) was the most common reported complication (1.6% of admissions), while cardiac arrest occurred in 0.1% of admissions.

SIGNIFICANCE

EMU staffing and safety practices vary across US epilepsy centers. Reported complications in EMUs are rare but could be further reduced, such as with more effective treatment or prevention of SE. These findings have potential implications for improving EMU safety and quality care.

Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial)

Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.