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IMPACT OF A CLINICAL PATHWAY ON THE MANAGEMENT OF FIRST SEIZURES AT A DISTRICT GENERAL HOSPITAL
  1. Zoya Georgieva1,
  2. Harith Altemimi2
  1. 1Addenbrooke's Hospital, Cambridge
  2. 2Queen Elizabeth Hospital, King's Lynn

Abstract

Diagnostic confidence and management of first seizures can be challenging, particularly for junior doctors. This audit evaluates the impact of a clinical pathway based on recommendations by the College of Emergency Medicine, which intended to improve the management of such patients at a UK DGH.

A systematic search identified cases spanning 3 months either side of the date of introduction of the pathway. 23 pre- and 25 post-pathway cases presenting to A&E or as inpatients were randomly selected, excluding cases with a known seizure-related diagnosis.

The pathway was only utilised in 16% of cases. Referral to neurology clinic increased from 30% to 52%, but attending within the recommended 2 weeks of ictus remained infrequent (8%). Clinical assessment worsened in several categories, including documenting a drug history, obtaining an ECG, and blood glucose measurement. Documenting discussions about driving decreased from 43% to 36%.

Findings confirm suboptimal investigation and follow-up of first seizures, with a surprising deterioration after introduction of a local clinical guideline. This audit demonstrates the importance of cultural change in addition to the availability of a structured guideline. We propose this can be achieved by dedicated junior doctor training sessions and development of a patient information leaflet.

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