981 Sort out my 1st seizure….QUICK

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A182-A182
• Main Authors: Sokhi, Jaspreet Kaur, Runnacles, Jane, Davey, Nicola, Hadjikoumi, Irene, Ghazavi, Malihe
• Format: Article
• Language: English
• Subjects: Abstracts; Anxiety; Children; Convulsions & seizures; Data Analysis; Epilepsy; Medical diagnosis; Pandemics; Patients; Pediatrics; Referral; Seizures
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.317

BackgroundNICE guidelines state that children with their first seizure should be seen by a specialist within two weeks. The Epilepsy 12 Audit Round 3, Cohort 1 2018–19 showed that only 15.5% of children with epilepsy were seen by a specialist within 2 weeks of referral.Our average waiting time from first seizure to seeing a specialist (January -August 2020) was 2 months. This led to a delay in seizure management and emotional anxiety to families and staff.ObjectivesTo decrease the time taken from referral to first clinic review, so as to decrease patient anxiety and improve seizure management, by March 2021MethodsUsing diagnostics (process map and fishbone diagram), I identified the process and areas of possible intervention.Two approaches were used1. Retrospective analysis of data obtained from our IT department on patients referred to first seizure/new epilepsy clinic, January - August 2020 to get a baseline measurement2. Prospective follow up of patients referred to the first seizure/new epilepsy clinic from referral to first clinic appointment. Ongoing since November 2020. This helped contribute to the baseline measurement as well as monitor the effect of PDSAsInclusions− Patients referred and 0–16 years oldExclusions− Referrals rejected due to wrong postcodeI held discussions with the team to identify areas that could be contributing to long waiting times and what we could improve. I re-consulted after every stage of data analysis to gain insights and perspectives from others regarding the nature and size of problems.I shared the analysis with the team via email followed by face to face discussion and continued to share data as I developed a baseline measure and charted changes.4 ideas were tested using series of PDSA cycles:1. Introduction of a generic email address for all referrals (3 cycles)2. Designing a standardised referral form to streamline referrals (6 cycles)3. Discussion with the IT team possibility of integrating referral form onto hospital electronic system (4 cycles)4. Uploading the referral form onto hospital intranet to make it accessible and creating awareness about new referral process (3 cycles)ResultsThe initial average waiting time was 83 days (median 63 days). Since the initiation of the PDSA series, the average waiting time has decreased to 47 days (median 54 days). It is however important to note that there have been fewer referrals due to the Covid pandemic since December (time of initiation of the 1st PDSA series) and thus t