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.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)