I read with interest the results of the Drees et al.1 study and agree with the process improvements highlighted to reduce the time for epilepsy surgery (ES) evaluation. My personal experience working in a level IV comprehensive epilepsy center has been as follows. Potential ES patients are identified relatively early and time for ES evaluation is relatively short provided patients are seen in the office practice setting of individual epileptologists. Patients seen in this setting tend to be more involved in their care, they have commercial medical insurance, and the treating epileptologist assumes care of these patients. Potential ES patients who are seen in the resident/fellow clinic setting experience the longest delay to ES. Patients and caregivers seen in this setting tend to be less involved in their care, may have a lower education status, usually lack commercial insurance, and no physician truly assumes the care of these patients. The patients are seen by residents and fellows and staffed by the attending epileptologist who is covering the clinic that week. On the next visit, it is not uncommon for the patient and caregiver to meet an altogether different epilepsy care team. Maintaining a database of all potential ES patients and having a nurse navigator who keeps track of the status of all the patients in this database should help streamline the process and reduce the ES evaluation time.
Disclosures:
N. Sethi serves as Associate Editor of The Eastern Journal of Neurology.
- © 2017 American Academy of Neurology
Authors Respond:
We agree with Dr. Sethi's observations regarding our article.1 An epilepsy provider who manages the patient was crucial for the surgical workup, but he or she may not be aware of which tests have been accomplished until the next office visit. In our institution, a nurse navigator was key to a streamlined processing of patients, actively facilitating testing, and keeping track of what tests had been scheduled and performed. In addition, the dedicated epilepsy surgery clinic allowed any provider to temporarily hand over patients for the presurgical consultations and testing to a dedicated provider, which ensured the fastest possible processing time.
We have not analyzed processing time with respect to insurance status, but we have encountered rejection of coverage for certain tests depending on insurance. Individual state regulations may also influence access to testing.
Disclosures:
C. Drees, S. Sillau, and M.-G. Brown report no disclosures. A. Abosch serves on a scientific advisory board for the Disease Modification in Early Parkinson's Disease Working Group (sponsored by APDA and PDF, Vanderbilt MC); has received speaker honoraria from RuiJen Hospital, Shanghai, China; serves as an Associate Editor for Stereotactic & Functional Neurosurgery, Journal of Neurosurgery, Neurology, and Psychiatry, and Neurosurgery; is author on a provisional patent re: Imaging Table-to-Head Frame Adaptor; and serves as a consultant for Medtronic.
References
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