Authors :
Presenting Author: Schweta Rane, MD – Baylor College of Medicine
Ana Sofia Rivera Fullana, MD – Baylor College of Medicine
Lu Lin, MD, PhD – Baylor College of Medicine
Rationale:
Status epilepticus incurs an average inpatient cost of $18,834 per admission in the U.S. and can extend hospital stays by 7 days if not promptly treated, increasing burdens on families and healthcare systems [Kortland, Lena-Marie, et al. "Cost of status epilepticus: a systematic review." Seizure 24 (2015): 17-20]. National guidelines recommend benzodiazepine administration within 5 minutes of seizure onset [Glauser, Tracy, et al. "Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society." Epilepsy currents 16.1 (2016): 48-61. ]. In Epilepsy Monitoring Units (EMUs), where seizures are induced, adherence to these standards is critical to minimizing morbidity, mortality, and critical care utilization. This study aimed to identify factors contributing to delayed treatment of convulsive status epilepticus (CSE) in the Baylor St. Luke’s EMU (BSLEMU).
Methods:
After IRB approval, this retrospective study analyzed EMR data from patients admitted to BSLEMU between January 2023 and December 2024. Collected variables included demographics, time of seizure onset and duration, time of intravenous (IV) lorazepam order and administration, indication, and dosage. CSE was defined as a convulsive seizure lasting >5 minutes or recurrent seizures without regained consciousness for total duration of ≥5 minutes. Following the Plan phase of the first Plan-Do-Study-Act (PDSA) Quality Improvement cycle, post-analysis meetings were held with EEG technologists, EMU nurses, physicians including faculty and trainees, and hospital pharmacist to identify care gaps.
Results:
Of 279 admitted patients, 62 received IV lorazepam. Among them, 30 were treated for non-CSE seizures, 11 received IV lorazepam as a bridge before resuming home antiseizure medications, 7 were treated for non-seizure indications (e.g., anxiety/agitation), and 1 received lorazepam during cortical mapping. The median time to administration of lorazepam for 13 CSE patients was 31 minutes. Only 37% patients had lorazepam as needed orders on admission, the others needed a new order to be placed after seizure occurred. The median time from a new order to administration was 12 minutes. No increase in \length of stay (LOS) was observed. Meetings with different groups identified care gaps in various domains, including delays in seizure identification and notification, delaying in medication ordering, as well as medication and supply retrieval.
Conclusions:
Although LOS remained unchanged, intervention times for CSE in BSLEMU significantly exceeded national guideline standard by almost 6 folds, necessitating targeted improvements. Analysis revealed gaps in multiple areas in clinical care. Future interventions will aim at education about seizure identification and notification, modifying admission order-set to mandate lorazepam order at admission, as well as centralizing and bundle medication with administration supplies.Funding:
This work was supported by the Accelerating Clinical Excellence grant.