title: Reduced Emergency Department Utilization by Patients With Epilepsy Using QI Methodology.
abstract: BACKGROUND
  Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014.
  
  
  METHODS
  Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model. Our defined outcome was to decrease ED utilization for children with epilepsy. Rate of ED visits as well as unplanned hospitalizations for epilepsy patients and associated health care costs were determined. A QI team was developed for this project. Plan do study act cycles were used with adjustments made when needed.
  
  
  RESULTS
  Nineteen months after implementation of the interventions, ED visits were reduced by 28% (from 17 visits per month per 1000 patients to 12.2 per month per 1000 patients) during the past year. The average number of inpatient hospitalizations per month was reduced by 43% from 7 admissions per month per 1000 patients to 4 admissions per month per 1000 patients. For both outcome measures, a 2-sample Poisson rate exact test yielded a P value < .0001. Health care claims paid were less with $115 200 reduction for ED visits and $1 951 137 reduction for hospitalizations.
  
  
  CONCLUSIONS
  Applying QI methodology was highly effective in reducing ED utilization and unplanned hospitalizations for children with epilepsy at a free-standing children's hospital.
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and anup.patel@nationwidechildrens.org.|Divisions of Neurology and.
authors.forename: Anup D
authors.initials: AD
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Wood
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.|Emergency Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cohen
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage; D002648:Child; D003376:Counseling; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D009820:Ohio / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D018802:Patient-Centered Care / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*
chemical_list: D000927:Anticonvulsants