The newly developed algorithms identified an extra 66% of epilepsy-related admissions when compared to just using the primary diagnosis code, now capturing more accurate average length of stay.
Epilepsy and seizures are the most common neurological reason for emergency presentations at hospital. They account for 1.5% of emergency admissions, and a similar number are discharged from the emergency department without admission. Many seizure admissions are preventable and improvements in care are needed. NICE guidelines recommend that patients experiencing their first-ever seizure should be seen in a seizure clinic within two weeks but this is rarely the case.
What the NWC CHC team did:
Developed a new algorithm to identify epilepsy-related seizure admissions, which went beyond the traditional approach of just using the primary diagnostic position. The NWC CHC used routinely collected hospital data to assess the impact of interventions such as the Walton Seizure Pathway and the Care After Presenting with Seizures (CAPS) Project and monitor the effect of these interventions on health inequalities.
Geographical data was analysed to allow patterns of high admissions rates to be identified and fed back to CCGs within Cheshire and Merseyside; this led to the planning of community-based epilepsy clinics.
Analysed routinely collected hospital data to identify unnecessary CT scans, highlighting inadequate coordination in care and leadership, wasted resources, and unnecessary exposure of patients to radiation.
As a result of these activities, the NWC CHC achieved:
Identification of an extra 66% of epilepsy-related admissions when compared to just using the primary diagnosis code. This cohort is more representative of the seizure population than those reported by other national groups, for instance, capturing a more accurate average length of stay.
Analysis of data showed that since the instigation of the Walton Seizure Pathway, the odds of getting a neurology referral within 3 months of a seizure admission were increased by 28% for those already known to the service, and by 48% for those newly identified. A further increase in the odds was observed for hospitals where nurses were employed part-time to facilitate referrals (by 105% for newly identified cases).
South Sefton CCG used geographical data relating to the source of epilepsy admissions to plan community-based epilepsy clinics, run in a local GP surgery by a Walton Centre neurologist.
Adoption of the NWC CHC algorithm at a national level including by the National Neurology Advisory Group (NNAG), and the NHSE Epilepsy Specialist Commissioning Review.
The GIRFT neurology group gained insights from the work undertaken by the NWC CHC team on using routine data to identify admissions and calculate referral rates, and now use the 3-month referral rate as a key metric on which to measure hospital performance.
The epilepsy pathway work also led to the PED4PED project, funded by MRC/ HDRUK, which aims to provide paramedics with access to epilepsy care records from secondary care in order to inform decisions about conveyance and immediate care.
Case study : New investment with the PED4PED Project – People with Epilepsy Sharing Data for Care with Paramedics and the Emergency Department .
PED4PED connects patient information from GPs, hospitals and ambulance services in the North West Coast and makes it available to paramedics and A&E staff when they are called to epilepsy patients requiring urgent care. It builds on the work by Connected Health Cities in the North West Coast, to transform health services by improving access to patient data. Working together are the Innovation Agency, University of Liverpool, Liverpool Health Partners, North West Ambulance Service NHS Trust, The Walton Centre NHS Foundation Trust, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Alder Hey Children’s NHS Foundation Trust, Epilepsy Action and Forcare.
“By making additional information accessible for our ambulance clinicians, they will be able to make more informed decisions based on the patient’s medical history. This means that if the patient could benefit more from care in the community, unnecessary A&E admissions can be avoided which in turn will free up vital emergency resources.” Mike Jackson , Chief Consultant Paramedic , North West Ambulance Service NHS Trust