Standardizing the Ictal Examination and Reducing Seizure Onset-to-Nurse Response Time in the Epilepsy Monitoring Unit
Abstract number :
2.158
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2025
Submission ID :
380
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Ashley Raedy, DO – University of Chicago
Alexandra Below, DO – University of Chicago
Diane Malinowski, MSN, RN, CNRN – University of Chicago
Shasha Wu, MD, PhD – University of Chicago
Rationale: The Epilepsy Monitoring Unit (EMU) is designed to provide continuous or extended video electroencephalographic (EEG) monitoring for patients, primarily to evaluate and manage seizure disorders. Seizures often occur in the EMU, but their short-lasting and unpredictable nature can make evaluation and care during these events challenging and stressful. A standardized ictal examination and a rapid nurse response are critical for optimizing patient safety and ensuring accurate and timely data collection during long-term EEG monitoring.
Methods: We retrospectively reviewed archived video EEG recordings from the adult EMU at the University of Chicago between July-November 2023 as a period of observation pre-intervention, and again between January-April 2025 post-intervention. We analyzed the components of the ictal examination performed during the seizures and measured the time from seizure onset to nurse response at bedside. An intervention was implemented to standardize the ictal exam in the EMU, which included an educational session for EMU nurses and the introduction of a bedside mnemonic resource, “SEIZURE”, to aid in recall for the following seven ictal exam components: Safety, Describe, Aura, Memory, Comprehension and Language, Orientation, and Motor (Figure 1). Pre- and post-intervention surveys were collected as a self-assessment for nurse competency and confidence in performing the ictal exam. Additionally, to reduce the time from seizure onset to nurse response, a new seizure alert system was developed and implemented to enable direct communication between EEG technologists and EMU nurses.
Results: There were 40 EMU patients reviewed pre-intervention and 40 EMU patients reviewed post-intervention. There were 66 seizures captured from 19 different patients pre-intervention, and 40 seizures captured from 14 different patients post-intervention. Prior to ictal exam standardization, 22 out of 66 seizures (33.3%) had at least three components of the ictal exam performed. Following standardization, this increased to 29 out of 40 seizures (72.5%) (Figure 2). Memory and Motor were the least frequently assessed components before the intervention. Post-intervention, Motor became one of the most frequently tested components, while Memory and Aura remained the least commonly assessed. With the implementation of the new seizure alert system, the average time from seizure onset to nurse bedside response decreased from 86.4 seconds pre-intervention to 35.0 seconds post-intervention.
Conclusions: Standardizing the ictal exam enhances consistency and efficiency among EMU nursing staff. Reducing nurse response time enables prompt intervention, which improves patient safety and increases the likelihood of capturing essential ictal data. Together, these two measures can significantly improve the quality and outcomes of EMU evaluations.
Funding: None.
Neurophysiology