Evaluating the single seizure clinic model: Findings from a Canadian Center.

Academic Article

Abstract

  • INTRODUCTION: The effect of the single seizure clinic (SSC) model on patient diagnose, work-up, wait-times, and clinical care is poorly characterized and its efficacy unclear. The present study assesses patient characteristics and evaluates the impact of a single seizure clinic (SSC) model on wait-times and access to care. MATERIAL AND METHODS: A prospective study of all patients (n=200) referred to our SSC for first seizure evaluation. Demographic, clinical, and paraclinicial variables were systematically collected and analyzed against a historical cohort. Binary logistic regression analysis was performed to predict impact of dichotomized variables on diagnosis of epilepsy. Diagnostic concordance between SSC nurses and epileptologists was also assessed. RESULTS: Predominant referral sources were emergency department physicians and general practitioners. Mean wait-time for first assessment was significantly reduced by 70.5% employing the SSC model versus historical usual care. A diagnosis was established at first-contact in 80.5% of cases while 16.0% of patients required a second visit. Eighty-two patients (41.0%) were diagnosed with epilepsy. An abnormal EEG was found in 93.9% of patients diagnosed with epilepsy. Sixty-three patients were started on anti-epileptic drugs (63.5% lamotrigine, 7.0% levetiracetam, 5.0% phenytoin, and 5.0% topiramate). In 18% of cases driving restrictions were initiated by the SSC. The most common non-seizure diagnosis was syncope (24.0%). DISCUSSION: The SSC reduced wait-times for assessment and investigations, clarified diagnoses, affected management decisions with respect to further workup, pharmacotherapy, and driving. There was moderate correlation between SSC nurses and physicians (kappa=0.54; p<0.001) as physicians were significantly more likely to diagnose epilepsy. Key factors identified as predictors of epilepsy were: presence of abnormalities on electroencephalography and imaging studies, patients stratified as high or medium-risk for seizure recurrence, semiological characteristics such as amnesia and limb stiffening, and presence of tongue trauma, or incontinence. CONCLUSIONS: The SSC model reduces wait-times, streamlines assessments, and impacts clinical care decisions.
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    Keywords

  • Diagnosis, Epilepsy, Health-care process improvement, Quality of life, Single seizure, Wait-times, Adolescent, Adult, Aged, Aged, 80 and over, Anticonvulsants, Delivery of Health Care, Electroencephalography, Epilepsy, Female, Humans, Logistic Models, Male, Middle Aged, Outpatient Clinics, Hospital, Prospective Studies, Quality Improvement, Referral and Consultation, Saskatchewan, Tertiary Care Centers, Time-to-Treatment, Young Adult
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    Author List

  • Rizvi S; Hernandez-Ronquillo L; Moien-Afshari F; Hunter G; Waterhouse K; Dash D; Téllez-Zenteno JF
  • Start Page

  • 203
  • End Page

  • 210
  • Volume

  • 367