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

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 (ACP) 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 ACP in a regional ambulance service in the United Kingdom. The ACP allowed paramedics to refer eligible patients to an epilepsy specialist nurse service.

Results The ambulance service managed 3,964 suspected seizure incidents in the study period (1 July 2015 – 31 May 2016) of which 22.5% (891 /3,964) were potentially eligible for the ACP. 9.8% (87/891) of the potentially eligible incidents were referred. The 87 incidents were generated by 74 individual patients. 97.3% (71/73) patients were contacted within the target time of 5 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 ACP 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 ACP 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.