Reasons for prolonged length of stay in the epilepsy monitoring unit.
Epilepsy monitoring unit (EMU) admissions are essential for the classification/localization of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). However, the duration of admissions is highly variable. Accordingly, we evaluated the duration of 596 EMU admissions and reasons for prolonged (>7 days) lengths of stay (LOS). The average LOS was longer for patients diagnosed with ES (8.0 days, SD 4.1 days) than all others (6.0 days, SD 3.9 days, p<0.001). Of the 596 admissions, 231 (38.8%) had prolonged LOS. The most commonly reported reason for prolonged stay was need to record additional seizures (33%). Other contributors included complications such as seizure clusters (6.9%), status epilepticus (1.6%), test complications (3.7%), psychiatric concerns (4.3%), and medication side effects (1.6%). Our results suggest multiple factors produce prolonged LOS with no factor accounting for the majority. Recording an insufficient number of all habitual seizures was the leading cause, which was over twice the percentage of reported complications (17.6%). However, being able to prolong admissions when necessary resulted in only 14.9% of admissions being inconclusive, potentially justifying the extra expense. Efforts to shorten LOS may be best directed at faster recording of seizures, but this may increase LOS due to complications. Our results may be helpful when assessing whether efforts to shorten LOS are useful in improving the quality and cost of care.
Department of Neurology and Rehabilitation Medicine, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH, 45267-0525, USA. Electronic address: briandmoseley@gmail.com.
Brian D
BD
Moseley
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA. Electronic address: SDewar@mednet.ucla.edu.
Sandra
S
Dewar
Department of Neurology, Baylor College of Medicine, One Baylor Plaza, MS: NB302, Houston, TX, 77030, USA. Electronic address: haneef@bcm.edu.
Zulfi
Z
Haneef
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA. Electronic address: DEliashiv@mednet.ucla.edu.
Dawn
D
Eliashiv
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA. Electronic address: JStern@ucla.edu.
John M
JM
Stern
D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D008991:Monitoring, Physiologic; D012640:Seizures / Q000175:diagnosis / Q000628:therapy; D014741:Video Recording
EMU; Epilepsy monitoring; Length of stay; Prolonged hospitalization; Resource allocation