Epilepsy in the accident and emergency department--developing a code of safe practice for adult patients. South East and South West Thames Accident and Emergency Specialty Sub-committees.
OBJECTIVE
To benchmark current practice in the management of adult patients presenting with seizures to the accident and emergency (A&E) departments by performing a comparative interdepartmental audit. To assess the quality and degree of completeness of documentation in A&E records and to develop a proforma for the documentation of any case presenting with a seizure which would incorporate management guidelines for use by A&E doctors.


METHODS
This was a retrospective, criterion based audit carried out in 12 A&E departments in the South Thames region. It involved 1200 adult patients who presented to A&E departments after a seizure. The degree of completeness of A&E records was assessed using criteria identified by A&E consultants and neurologists. Guidelines for use in the management of patients with seizures have been produced.


RESULTS
Important aspects of the history and examination were frequently unrecorded in patients' notes. The recording of vital signs was particularly poor. A diversity of practice was shown between the departments that were audited and the number of investigations performed in each department varied considerably. Hospital admissions for patients with first seizures varied widely between departments, ranging from between 34.6% to 91.7% of cases. Documentation of advice given to patients about driving was evident in just 0.9% of cases.


CONCLUSIONS
Wide interdepartmental variation exists in both the quality of information recorded in A&E records and in the management of patients. Deficiencies could be minimised and potential improvements in the quality of documentation might be achieved by the introduction of a structured proforma incorporating pre-defined management guidelines.
Department of Accident and Emergency Medicine, Royal Sussex County Hospital, Brighton. ryanj@pavilion.co.uk
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Ryan
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Nash
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Lyndon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D004282:Documentation / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D004739:England; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies