RT Journal Article
SR Electronic
T1 Developing and Implementing a Standardized Ictal Examination in the Epilepsy Monitoring Unit
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP 127
OP 133
DO 10.1212/CPJ.0000000000000815
VO 11
IS 2
A1 Susanna S. O'Kula
A1 Lisa Faillace
A1 Catherine V. Kulick-Soper
A1 Sahily Reyes-Esteves
A1 Jackie Raab
A1 Kathryn A. Davis
A1 Ammar Kheder
A1 Chloe E. Hill
YR 2021
UL http://cp.neurology.org/content/11/2/127.abstract
AB Background The ictal examination is crucial for neuroanatomic localization of seizure onset, which informs medical and neurosurgical treatment of epilepsy. Substantial variation exists in ictal examination performance in epilepsy monitoring units (EMUs). We developed and implemented a standardized examination to facilitate rapid, reliable execution of all testing domains and adherence to patient safety maneuvers.Methods Following observation of examination performance, root cause analysis of barriers, and review of consensus guidelines, an ictal examination was developed and disseminated. In accordance with quality improvement methodology, revisions were enacted following the initial intervention, including differentiation between pathways for convulsive and nonconvulsive seizures. We evaluated ictal examination fidelity, efficiency, and EMU staff satisfaction before and after the intervention.Results We identified barriers to ictal examination performance as confusion regarding ictal examination protocol, inadequate education of the rationale for the examination and its components, and lack of awareness of patient-specific goals. Over an 18-month period, 100 ictal examinations were reviewed, 50 convulsive and 50 nonconvulsive. Ictal examination performance varied during the study period without sustained improvement for convulsive or nonconvulsive seizure examination. The new examination was faster to perform (0.8 vs 1.5 minutes). Postintervention, EMU staff expressed satisfaction with the examination, but many still did not understand why certain components were performed.Conclusion We identified key barriers to EMU ictal assessment and completed real-world testing of a standardized, streamlined ictal examination. We found it challenging to reliably change ictal examination performance in our EMU; further study of implementation is warranted.