Patient-centered outcomes: a qualitative exploration of patient experience with electroencephalograms in the Emergency Department

Christine S. Davis; Sandra K. Beverly, MD; Jackeline Hernandez-Nino; Andrew J. Wyman; Andrew W. Asimos

doi:10.4081/qrmh.2017.6219

Authors

Christine S. Davis
christine.s.davis@uncc.edu
University of North Carolina at Charlotte, Department of Communications, Charlotte NC, United States.
Sandra K. Beverly, MD Carolinas Healthcare System, Department of Emergency Medicine, Charlotte NC, United States.
Jackeline Hernandez-Nino Carolinas Healthcare System, Department of Emergency Medicine, Charlotte NC, United States.
Andrew J. Wyman Carolinas Healthcare System, Department of Emergency Medicine, Charlotte NC, United States.
Andrew W. Asimos Carolinas Healthcare System, Department of Emergency Medicine, Charlotte NC, United States.

The primary objective of this qualitative project was to understand the experience of patients who had first-time seizures and who did, and did not, have electroencephalograms (EEGs) performed in the Emergency Department (ED) as part of their initial evaluation, so as to refine the diagnostic and therapeutic approach to these patients and transform the standard of care for first-time seizures by focusing on outcomes as defined by patient experiences and expectations. In this paper, we show that, regardless of the diagnostic and therapeutic approach patients are given in the ED, patients and caregivers trust that health care providers will perform the standard of care consistent with the current medical practice for first-time seizures. However, performing EEGs in the ED and initiating appropriate anticonvulsant therapy for those patients who are at high risk for future seizures addresses patient needs by offering patients a sense of security and control over their medical condition and expediting appropriate follow up care, as long as clearly stated written diagnostic, treatment, and referral instructions are provided upon discharge.

ACEP Clinical Policies Committee, Clinical Policies Subcommittee on Seizures. (2004). Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Annals of Emergency Medicine, 43(5), 605-625. DOI: https://doi.org/10.1016/j.annemergmed.2004.01.017

Asbury, J. (1995). Overview of focus group research. Qualitative Health Research, 5, 414-420. DOI: https://doi.org/10.1177/104973239500500402

Barratt, A. (2008). Evidence based medicine and shared decision making: The challenge of getting both evidence and preferences into health care. Patient Education and Counseling, 73, 407-412. DOI: https://doi.org/10.1016/j.pec.2008.07.054

Becker, E. R., Hockenberry, J. M., Bae, J., Avgar, A., Liu, S. S., Wilson, I. & Milstein, A. (2014). Factors in patients’ experience of hospital care: Evidence from California, 2009-2011. Patient Experience Journal, 1(1), 95-110. DOI: https://doi.org/10.35680/2372-0247.1014

Biraben, A., Taussig, D., Thomas, P., Even, C., Vignal, J., Scarabin, J., & Chauvel, P. (2001). Fear as the main feature of epileptic seizures. Journal of Neurology, Neurosurgery, and Psychiatry, 70(2), 186–191. doi:10.1136/jnnp.70.2.186 DOI: https://doi.org/10.1136/jnnp.70.2.186

Brodt, A., Norton, C. K., & Kratchman, A. (2015). So much more than a “pair of brown shoes”: Triumphs of patient and other stakeholder engagement in patient-centered outcomes research. Patient Experience Journal, 2(1), 43-49. DOI: https://doi.org/10.35680/2372-0247.1057

Burns, J. (2012, December). What works best for patients? PCORI hopes to provide answers. Managed Care Magazine Online, np. Retrieved from http://www.managedcaremag.com

Carey, M. A. (1994). The group effect in focus groups: Planning, implementing, and interpreting focus group research. In J. M. Morse (Ed.), Critical Issues in Qualitative Research Methods (pp. 234–241). Thousand Oaks, CA, Sage.

Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (pp. 509-535). Thousand Oaks, CA: Sage.

Davis, C. S. (2017). Focus Groups: Applying Communication Theory through Design, Facilitation and Analysis. New York, NY: Routledge.

Davis, C.S., & Lachlan, K. (2017). Straight talk about communication research methods (3rd Ed.). Dubuque, IA: Kendall-Hunt.

Eisner, R., Turnbull, T., Howes, D., & Gold, I. (1986). Efficacy of a standard seizure workup in the ED.. Annals of Emergency Medicine, 15(1), 33-39. DOI: https://doi.org/10.1016/S0196-0644(86)80483-8

Hauser, W. A., et al. (1990) Seizure recurrence after a first unprovoked seizure: An extended follow-up. Neurology, 40(8), 1163-1170. DOI: https://doi.org/10.1212/WNL.40.8.1163

Huff, J. S., et al. (2014). Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Annals of Emergency Medicine, 63(4), 437-447. DOI: https://doi.org/10.1016/j.annemergmed.2014.01.018

Kadambi, P., et al. (2015). Electroencephalography findings in patients presenting to the ED for the evaluation of seizures. American Journal of Emergency Medicine, 33,100-103. DOI: https://doi.org/10.1016/j.ajem.2014.10.041

King, M., Newton, M., & Jackson, G., et al. (1998). Epileptology of the first-time seizure presentation: A clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet, 352, 1007-1011. DOI: https://doi.org/10.1016/S0140-6736(98)03543-0

Krueger, R. A. (1998). Moderating focus groups. Thousand Oaks, CA: Sage. DOI: https://doi.org/10.4135/9781483328133

Krumholz, A., et al. (2015). Neurology, 84(1), 705–1713. DOI: https://doi.org/10.1212/WNL.0000000000001487

Lee, E. O. & Emanuel, E. J. (2013). Shared decision making to improve care and reduce costs. The New England Journal of Medicine, 368(1), 6-8. DOI: https://doi.org/10.1056/NEJMp1209500

Newhouse, R., Barksdale, D. J., & Miller, J. A. (2015). The patient-centered outcomes research institute: Research done differently. Nursing Research, 64(1), 72-77. doi: 10.1097/NNR.0000000000000070 DOI: https://doi.org/10.1097/NNR.0000000000000070

Praline J, Grujic J, & Corcia P., et al. (2007). Emergent EEG in clinical practice. Clinical Neurophysiology, 118, 2149–2155. DOI: https://doi.org/10.1016/j.clinph.2007.07.003

Ryan, S., & Räisänen, U. (2012). “The brain is such a delicate thing”: An exploration of fear and seizures among young people with epilepsy. Chronic Illness, 8(3), 214-224. DOI: https://doi.org/10.1177/1742395312449666

Sadleir, L., & Ingrid, S. (2010). Optimizing electroencephalographic studies for epilepsy diagnosis in children with new-onset seizures. Archives of Neurology, 67(11), 1345-1349. DOI: https://doi.org/10.1001/archneurol.2010.155

Sequist, T. D. & Taveras, E. M. (2014). Clinic-community linkages for high-value care. The New England Journal of Medicine, 371(23), 2148-2150. DOI: https://doi.org/10.1056/NEJMp1408457

Vranceanu, A., Cooper, C., & Ring, D. (2009). Integrating patient values into evidence-based practice: Effective communication for shared decision-making. Hand Clinics, 25, 83-96. DOI: https://doi.org/10.1016/j.hcl.2008.09.003

Weinstein, S. (2007). Seizures and teens: The impact of seizures and epilepsy on families. Exceptional Parent, 37(6), 61-65.

Wyman A., Mayes B., Hernandez-Nin J., Rozario N., & Asimos A.W. (2015). The First Time Seizure (FITS) ED EEG study. Academic Emergency Medicine, 22, S138.

Zehtabchi, S., et al. (2014). Effect of micro-electroencephalogram on clinical management and outcomes of emergency department patients with altered mental status: A randomized controlled trial. Academic Emergency Medicine, 21(3), 283-291. DOI: https://doi.org/10.1111/acem.12324

Ziai, W.C., Schlattman, D., Llinas, R., Venkatesha, S., Truesdale, M., & Schevchenko, A. (2012). Emergent EEG in the emergency department in patients with altered mental states. Clinical Neurophysiology, 123, 910–917. DOI: https://doi.org/10.1016/j.clinph.2011.07.053

Davis, Christine S., Sandra K. Beverly, MD, Jackeline Hernandez-Nino, Andrew J. Wyman, and Andrew W. Asimos. 2017. “Patient-Centered Outcomes: A Qualitative Exploration of Patient Experience With Electroencephalograms in the Emergency Department”. Qualitative Research in Medicine and Healthcare 1 (3). https://doi.org/10.4081/qrmh.2017.6219.