The Danish Epilepsy Center in Copenhagen, has led an international research project, designed to study the current practices in European EMUs (Epilepsy Monitoring Units), with importance given to patient safety issues (SAEs).
A 37-item questionnaire investigating characteristics and the organisational structures of EMUs, including measures for the prevention and management of seizure-related serious adverse events was distributed to a total of 150 European centres, including one located in Israel.
These are the results which are published in the medical journal Epilepsy & Behavior:
- 48 (32%) EMUs completed the questionnaire, from 18 European countries.
- 43% of the centres had 1-2 beds
- 34% had 3-4 beds
- 19% had 5-6 beds
- 32% had 1-2 staff physicians
- 34% had 3-4 staff physicians
- 19% had 5-6 staff physicians
- 69% had epileptologists working in them
- 46% had clinical neurophysiologists trained in epilepsy
- 35% had child neurologists
- 46% & 8% respectively had neurology and clinical neurophysiology residents
- 27% had neurologists not trained in epilepsy
In 20% of EMUs, patient observation was irregular or only took place during the daytime, and was primarily carried out either by neurophysiology technicians and/or nurses (in 71% of EMUs), and 40% of these observations were done by patients' relatives.
Procedures for the management of acute seizures were found lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consisting of bed protections were reported in 96% of EMUs, whereas anti-smother safety pillows were employed in 21%. Environmental protections in monitoring rooms and bathrooms were done in 38% and in 25% of EMUs, respectively. The most common SAEs in EMUs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67%.
The researchers concluded: "All EMUs have faced different types of serious adverse events. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of serious adverse events. Our findings highlight the need for standardised and shared protocols for an effective and safe management of patients in EMUs."
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