Authors (including presenting author) :
Tse C(1), Leung H(1), Mok V(1), Chan L(2), Yeung J(2), Ip S(3), Li SH(3)
Affiliation :
(1) Department of Medicine and Therapeutics, Prince of Wales Hospital (2) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital (3) Department of Medicine, North District Hospital
Introduction :
Seizure disorders belong to an important category of neurological disease, causing significant morbidity and burden on healthcare. In the New Territories East Cluster(NTEC), an annual hospitalisation rate was 1042 (in 2019) with a mean acute length of stay of 9 days and a 28-day readmission rate of 33%. Effective treatment for epilepsy includes anti-epileptic drugs and epilepsy surgery.
Objectives :
We propose a strategy of multi-dimensional nursing interventions to support the existing medical and surgical treatment and to reduce hospital length of stay and/or re-admission rates.
Methodology :
A pilot nursing staff may perform screening for patients admitted with 12 diagnostic labels – “seizure, epilepsy, grand-mal, convulsion, fit, generalized tonic-clonic seizure, status epilepticus, loss of consciousness, syncope, collapse, confusion, dizziness”. The following nursing interventions were offered to target length of stay: early electroencephalography and seizure-syncope score. The following nursing interventions were offered to target readmissions: drug compliance check, alignment of psychosocial needs, rescue therapy (rectal), new drug titration and epilepsy hotline.
Result & Outcome :
A total of 81 patients were screened by our pilot study in the period of 17/10-27/12/2019. The mean age of the patients was 51 and 49.4% of patients were female. The percentage of refractory epilepsy within this cohort was 38% (31/81). The mean length of stay for the index admission with nursing assistance delivered was found to be 6.6 days (n=81). This represented a reduction of 26.7% in the length of stay when compared with the cluster’s baseline length of stay. The proportion of patients with 28-day pre-screening admissions was 23.5%(19/81). After the nursing assistance had been offered, the proportion of patients with 28-day post-screening admissions was 20%(17/81). This calculation was based on all types of admission and with admissions not limited to one hospital. The mean number of readmissions per patient was 0.25 in the pre-screening period whereas the mean number of readmissions per patient was 0.23 in the post-screening period. This represented only an 8%(0.02/0.25) reduction in readmissions after the nursing interventions. Nursing interventions ahead of medical consultations may reduce the length of stay. A more significant reduction in the number of readmissions may require a longer period of intervention and possibly with more effective rescue therapies (e.g. intranasal) and additional EEG slots offering pre-surgical evaluations.
