Abstracts

Rationale: Pediatric epilepsy surgery patients frequently have behaviors or mental health issues that impact the safety of the child, family or staff. An interdisciplinary process was developed, at a large midwestern pediatric medical center, to enhance safety during epilepsy surgery inpatient admissions or related outpatient visits. The aim of this new approach was to, first, identify safety problems for children going through the multistaged surgical process and, then, to develop a strategic plan to lessen serious safety events and assist families in having more positive hospital experiences. Methods: Formulation of this approach included 24 of 43 children with medically-resistant epilepsy who had a history of aggression, threatening behavior, self-destructive behavior, significant anxiety or a psychotic mental health disorder. All children that had been referred to the epilepsy surgery program from June 2011 through March 2012 were included, regardless of the reason for referral. Chidlren were scheduled for new-patient visits, involved in Phase I testing, undergoing surgical procedures or being evaluated in clinic for pre and post-operative visits. The hospital's serious safety data was reviewed and safety events involving epilepsy surgery patients tracked. Hospital resources, interdisciplinary colleagues and components of the safety process were identified. An algorithm was created to outline the steps and flow of the safety process which would meet child, family and staff needs. Results: We identified 11 out of 24 children who would benefit from a multidisciplinary safety approach during evaluation or surgery. These children had a history of aggression to people or animals, schizophrenia, obsessive compulsive disorder, anxiety, pervasive developmental disorder or autism. Prior to implementation of the safety process, two staff members and one parent were injured in clinic, one staff member was hurt in the emergency department and two staff were injured on the epilepsy monitoring unit. Since implementing this process, there have been no serious safety events. Increased satisfaction with the safety process and inpatient hospital stays was reported by careproviders and parents Conclusions: This new approach, described in the algorithm, demonstrates the feasibility of reducing the number and severity of serious safety events and improving family satisfaction with early identification of at-risk patients, advance planning and notification of disciplines in respective areas, use of multi-disciplinary research, and implementation of the safety process , along with continual evaluation to maintain safety and improve the process. Secondary outcomes included use of this approach as a model for developing a hospital-wide Behavior Safety Team with the goal to decrease serious safety events hospital-wide and increasing patient-family satisfaction with the hospital experience. In addidtion, children who may not have been epilepsy surgery candidates for surgery because of mental health issues are now able to fully evaluated and considered for surgical intervention.