Abstracts

Rationale: Adolescents and young adults (AYA) with epilepsy are particularly vulnerable during transition from pediatric to adult epilepsy care. The purpose of this Quality Improvement Project (QIP) was to improve transition through timely and effective communication and enhance team collaboration. Epilepsy social workers perform a unique role in assisting the patient and family with issues such as understanding differences in adult and pediatric care, patients rights with protected health information, guardianship, health insurance coverage, and providing information about community resources. One challenge identified by the pediatric epilepsy team at Children s Hospital Colorado was the lack of streamlined and effective communication between providers, nurses and the team social worker for proactive transition planning. Methods: A planning team consisting of the epilepsy social worker, providers (MD, NP, and PA) and nurses was convened by the project lead and met over several months to define issues and approaches. Multiple Plan-Do-Study-Act cycles lead to the development and implementation of a Clinical Decision Support (CDS) tool in the Electronic Medical Record (EMR). Technical support was provided by the hospital CDS team. A Best Practice Advisory (BPA) with a smart text template was developed, trialed, and revised by the team. The alert triggers when the provider opens the order entry field for all patients ages 16 years and older with an epilepsy diagnosis code. Providers can accept the alert, triggering an order to the social worker for consultation to begin transition discussions; or defer the alert until the next clinic visit if the timing was not appropriate. If accepted, the order allows detailing of individualized patient needs using drop down statement choices developed by the project team, and/or a free text option. Results: Statistical process analysis was used to track change over time, and is ongoing. Referrals to social work after the implementation of the decision support tool in the EMR improved from 5.8% to 27.5% of eligible patients over a six month period from late 2011 to early 2012, z = 10.0, p = 0.0006, OR = 6.13. In addition, anecdotal reports from the social worker indicate clearer and more consistent information leading to more effective and timely intervention with the patient and family. Conclusions: Many national organizations have identified care transitions as an essential element of achieving effective outcomes, including a need for improved communication among care teams for chronic illness populations. This QIP demonstrated the utility of using the EMR to address a specific health care need of AYA with epilepsy. Clinical Decision Support is an effective tool for facilitating team communications and increasing referrals for social work support through transition. The BPA reduces institutional barriers and improves processes to support transition to adult epilepsy care. Expansion to other neurology sub-specialty teams is underway.