Abstracts

Rationale: Close follow up after EMU discharge can help improve quality of care and patient safety by assessing patients' understanding and follow through of the care plan given to them prior to EMU discharge. Methods: We started an initiative to improve quality of care after discharge from the Epilepsy Monitoring Unit. Patients are asked to follow up with the epilepsy nurse practitioner 2-3 weeks after discharge, instead of the previously standard 3-4 months. At that visit the patients discuss their understanding of the diagnosis, studies that were ordered after the discharge, consults from any other specialties, and any medication changes that were recommended. This follow up includes all patients who were discharged from the EMU. Outcomes assessed include progress of pre-surgical workup, antiepileptic therapy adherence and safety, and patient understanding of diagnoses. Results: Out of 117 admissions from November 2013 through April 2013, 46% of patients were scheduled for follow up visits and the remaining 54% were not scheduled for a variety of reasons. 37% of patients who were scheduled did not show or cancelled their appointment. The majority of these patients (60%) had been diagnosed with psychogenic non-epileptic events. To remedy this, we have been working with our psychiatry team to improve the specific care given to the psychogenic non-epileptic patients, beginning at the time the diagnosis is confirmed in the EMU. As a result, the follow up of these patients have increased. Other results include, 23% of the patients admitted for pre-surgical evaluation had some delay in scheduling studies, which in turn delayed the surgical process. 20% had poor understanding regarding medications that were initiated, or they had unreported medication side effects. 17% had not yet followed up with outside consults, including psychiatry. One patient who followed up after pre-surgical evaluation had not had their vagal nerve stimulator turned back on prior to discharge. The remaining patients had appropriately followed through with their discharge instructions and had a clear understanding of their diagnosis and plan. Conclusions: Preliminary results of our program have demonstrated that the transition from inpatient to outpatient care is complex. We found that the most important problem was that the psychogenic non-epileptic patients were not showing to follow up visits. This problem improved once psychiatry took a more active inpatient role in diagnosis. Some other problems we found that could be ameliorated through better inpatient care include errors in arranging pre-surgical workup and poor patient understanding of medication side effects. Other problems do not seem easily remediated by better inpatient planning, such as the emergence of unreported side effects subsequent to discharge and the failure to see outpatient consults. Therefore, close follow up of patients once they are discharged from the EMU is essential. This initiative has been instrumental in identifying and fixing problems that can be addressed prior to discharge and those that arise in the few weeks afterwards, in turn improving quality of care that is being delivered.