Abstracts

Rationale: Accurate and reliable data are important for tracking the quality of care in epilepsy clinics. The aim of this quality improvement project was to improve seizure frequency documentation including date of last seizure and ILAE (International League Against Epilepsy) classification by at least 50% over a two-month period. These three fields were identified as having clinical significance in determining how well patients are responding to treatment and if medication adjustments are needed. In addition, these fields have been identified by the Epilepsy Learning Healthcare System (ELHS) as priorities for documentation.

Methods: We surveyed seven epileptologists to collect data on perceived seizure frequency documentation including date of last seizure as well as ILAE classification. Baseline data was then collected weekly from September to December 2021. We then tested a change in documentation for improvement by creating a new flowsheet within the electronic health record (EHR) prompting epileptologists to enter seizure frequency, ILAE classification, and date of last seizure. This flowsheet was tested in two epileptologist’s clinics between February and April 2022. Data was collected on a weekly basis and compared to documentation from other physicians within the same group.

Results: Epileptologists at our center subjectively believed they document seizure frequency for 90% (SD 13.4) of clinic visits, baseline data collection showed they documented seizure frequency for 83% (SD 18.7) of clinic visits. Subjectively, epileptologists believed they documented ILAE classification for 42% (SD 35.2) of clinic visits, baseline data showed this was documented in 33% (SD 20.5) of clinic visits. They also subjectively reported documenting date of last seizure for 55% (SD 32.3) of clinic visits, baseline data showed this was documented in 35% (SD 22.7) of clinic visits (Table 1). After implementing a new EHR flowsheet, documentation increased to near 100% for all fields (Figure 1).

Conclusions: The aim of this quality improvement project was to increase the documentation of seizure frequency including date of last seizure and ILAE classification by at least 50% over two months. We demonstrated that by implementing a standardized EHR documentation flowsheet, our documentation of seizure frequency improved from 83% to 100%, ILAE classification from 33% to 97%, and date of last seizure from 35% to 100%. In addition, we discovered discrepancies between subjective and objective documentation habits. These findings emphasize the need for a more objective tool to track documentation practices and show that simple interventions can make a substantial improvement in clinically meaningful documentation in epilepsy clinics.

Funding: None