528: SEIZURE MANAGEMENT AND ITS IMPACT ON CODE BLUE/RRT EVENTS IN A TERTIARY CARE CHILDREN'S HOSPITAL


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Abstract

Introduction: Seizures are the leading cause of code blue activations for inpatients outside of the ICU in our institution (63/198 from Jan 2009-June 2013). More of the events occurred on units other than our epilepsy monitoring unit (EMU). Further analysis was performed to determine if differences exist in patient management and team response. Methods: We are a tertiary care children's hospital. The EMU is an eight bed unit that admits patients to the neurology service for diagnostic work up of seizures. Other patients with new onset seizures or seizures as a co-morbidity are admitted on the general inpatient units and are cared for by a primary medical team with neurology as a consulting service. Data on all code blue/RRT events in the organization are entered into a secured database through chart reviews. Seizure code blue/RRT events for patients on the inpatient units from Jan 2009 – June 2013 (n=175) were further reviewed for characteristics of the event and response. Events were divided into two groups: patients on the EMU at time of event (n=19) and patients outside the EMU (n=156). Results: During Jan 2009-June 2013, the EMU had 19 code blue/RRT events. Other units had 156 events. 79% (15/19) of the EMU events had rescue medications ordered compared to 49% (76/156) on other units. For patients that had seizure activity within 12 hours prior to the event, 85% (11/13) of EMU events had rescue medications ordered compared to 66% (54/82) on other units. Patients on other units had a 72% transfer rate to the ICU compared to 63% of EMU patients. Since March 2010, patients transferred to the ICU were tracked for escalation of care including intubation, vasopressors, NIV or other significant events within 12 hours of transfer. The EMU had 7 events with transfer to the ICU; 2 (29%) required advanced support, both initiation of a versed drip. Other units had 87 events; 44 (51%) required advanced support, including emergent intubations (15/87). Conclusions: Code blue and RRT events due to seizures occurred more often on non-EMU units. These patients had a higher rate of transfer to the ICU and escalation of care, potentially leading to longer hospital stays and increased morbidity. These findings support the need for further analysis and multidisciplinary process improvement work to optimize management of patients with seizures outside of the ICU and prevent further escalation and deterioration.

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