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    An alternative care pathway for suspected seizures in pre-hospital care: a service evaluation

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    Author
    Dickson, Jon M.
    Rawlings, Gregg H.
    Grünewald, Richard A.
    Miles, Kate
    Mack, Carina
    Heywood, Thomas
    Reuber, Markus
    Keyword
    Emergency Medical Services
    Epilepsy
    Neurology
    Emergency Medicine
    Health Economics
    Journal title
    British Paramedic Journal
    
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    URI
    http://hdl.handle.net/20.500.12417/202
    DOI
    10.29045/14784726.2017.2.2.22
    Abstract
    Abstract published with permission. Introduction ‐ An uncomplicated, self-limiting epileptic seizure in a patient with an established diagnosis of epilepsy usually requires only first aid, but in the UK it is estimated that 75% of these patients are transported to hospital and many are discharged without review or follow-up with an epilepsy specialist. Alternative care pathways have the potential to reduce unnecessary conveyance to hospital and to improve rates of epilepsy specialist follow-up, and thereby increase the quality and cost effectiveness of care. Methods ‐ A service evaluation of a new alternative care pathway in a regional ambulance service in the UK. The alternative care pathway allowed paramedics to refer eligible patients to an epilepsy specialist nurse service. Results ‐ The ambulance service managed 3964 suspected seizure incidents in the study period (1 July 2015‐31 May 2016), of which 22.5% (891/3964) were potentially eligible for the alternative care pathway. Of the potentially eligible incidents, 9.8% (87/891) were referred. The 87 incidents were generated by 74 individual patients. A total of 97.3% (71/73) patients were contacted within the target time of five days, the average time taken for each phone call was 10 minutes and the average additional work load generated by each call was 10 minutes. There was a positive outcome in 55% (48/87) of incidents. Conclusions ‐ An alternative care pathway for people after a suspected seizure has the potential to safely reduce rates of transport to hospital and to improve care for people with epilepsy. However, paramedics in our study used the alternative care pathway for only a small proportion of those patients who were potentially eligible. Further research is required to develop tools to support paramedics to confidently identify patients that are suitable for management without transport to hospital.
    ae974a485f413a2113503eed53cd6c53
    10.29045/14784726.2017.2.2.22
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    Publications - Yorkshire Ambulance Service

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