O3320: Standardizing Seizure Referral Pathways in the Transfer Center: A Quality Improvement Project to Enhance Pediatric Consultation Efficiency and Outcomes.

Purpose/Objectives: Optimizing patient outcomes relies on ensuring that the right care is delivered at the right time to the right patients. Our facility’s Transfer Center identified an opportunity to improve the referral and consultation process for pediatric patients with seizures located at partner facilities. Traditionally, referral through the Transfer Center involves a telephone consultation with a medical control physician (MCP), typically a pediatric intensivist, who triages and provides management advice. In many cases, the MCP may accept patients for direct admission to the hospital during this telephone encounter. This quality improvement (QI) project aims to implement and increase the utilization of standardized seizure consultation guidelines by Transfer Center to appropriately direct referrals to either Neurology or MCP for pediatric patients with seizures, from 0% to 30% by July 1, 2024.

Design/Methods: The improvement was conducted at a large, free standing children’s hospital. A multidisciplinary team employed the Model for Improvement framework to guide the project. Key interventions included the development of standardized consultation guidelines and integration of these guidelines into the electronic medical record (EMR). These interventions were tested and refined through Plan-Do-Study-Act (PDSA) cycles. The primary outcome was the accurate identification of the correct consultant (MCP vs Pediatric Neurologist) by the Transfer Center staff. Secondary outcomes included whether increased process compliance correlated with a higher rate of ‘consult-only’ encounters and thus fewer avoidable transfers. An important balancing measure was monitoring patient return to the emergency department (ED) after a consult-only encounter. Guidelines were implemented on April 03, 2024.

Results: From the implementation of the guidelines through the target date of July 1, 2024, 86 seizure referrals were processed. The rate of correct first-call referrals increased incrementally from baseline of 0% to 40% by the end of the intervention period (Control chart, Figure 1). Process non-compliance was primarily related to issues with process tracking. Over the subsequent 6 months, process compliance improved to 89% and the rate of ‘consult-only’ encounters increased from a pre-study baseline of 39% to 77% by the end of 2024 (Control Chart, Figure 2). Notably, no consult-only patients required a return to the ED for seizure recurrence after discharge.

Conclusion/Discussion: The implementation of standardized consultation guidelines for seizure referrals through the Transfer Center resulted in increased Pediatric Neurology consultation and a significant reduction in avoidable transfers. The study’s initial improvement aim was exceeded. Insights gained from this QI initiative will inform future projects aimed at improving outcomes for other pediatric patient populations and subspecialty consultation.