Abstract
PurposeEmergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. MethodsWe conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. ResultsParticipants’ choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. ConclusionImproving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.
Highlights
Around 20% of people with epilepsy (PWE) visit a hospital emergency department (ED) each year [1,2,3,4]
In the UK, most PWE are managed by their general practitioner (GP) with a minority referred back to a specialist to monitor a change in care needs
National Audit of Seizure Management in Hospitals (NASH) found that most PWE visiting ED were not known to a specialist when they arrived, and going to ED did not change this, despite evidence that they might have been helped by such input
Summary
Around 20% of people with epilepsy (PWE) visit a hospital emergency department (ED) each year [1,2,3,4]. Nine out of 10 PWE arrive at ED by ambulance [5,6] Such visits are expensive, with around half of them resulting in admission [7]. In the UK, most PWE are managed by their general practitioner (GP) with a minority referred back to a specialist to monitor a change in care needs (e.g., sezure control). NASH found that most PWE visiting ED were not known to a specialist when they arrived, and going to ED did not change this, despite evidence that they might have been helped by such input. It is not surprising that ∼60% of PWE attending ED reattend in the 12 months [4]
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