Abstract Details

Seizures are a common presentation to the emergency department (ED) and the hospital setting. PNES are often misdiagnosed as epileptic seizures or status epilepticus, and patients are subject to aggressive interventions including sedation, intubations, and prolonged hospital admissions. Strategies are needed to reduce the rate of iatrogenic interventions and resource utilization in patients with PNES. An EMR alarm was implemented in 2016 for all patients with a diagnosis of PNES at Rush University Medical Center (RUMC). It reminds healthcare providers of the diagnosis and provides education upon interacting with the patient’s chart.

The diagnosis and treatment of psychogenic non-epileptic seizures (PNES) in the inpatient setting represents a challenge for clinical teams. The uncertainty about the diagnosis results in unnecessary treatment and potentially iatrogenic interventions. This study evaluates the effectiveness of an electronic medical record (EMR) alarm in preventing iatrogenic interventions in the inpatient setting for patients with a diagnosis of PNES.

A retrospective chart review was performed on all patients who presented to RUMC between 1/1/2017 and 12/31/2019 and had a PNES alarm triggered. Data from ED visits and inpatient admissions were compared between the year before (T-1) and the year after (T+1) the first time the alarm was triggered for each patient. A Wilcoxon signed-rank test was used for analysis.

The alarm was triggered in 179 patients. 143 (80%) were female. Mean age was 41, ranging from 18 to 81 years. There was a significant (p<0.05) decrease in the number of ED visits, hospital admissions, ICU admissions, and interventions such as intubations and rescue benzodiazepine use in the year after the alarm was triggered compared to the year prior. No adverse events were identified in relation to the alarm.

An EMR alarm can be a safe and effective tool in preventing potential iatrogenic interventions in patients with PNES.