Moving evidence based guidelines for seizures into practice in the emergency department: What's stopping us?

- ED clinicians believe that patients on the integrated care pathway receive higher standard of care.
- The barriers to pathway use in an ED setting are related to environmental, pathway design or individual user challenges.
- Identification of the implementation difficulties within a real working environment allows for practical changes improving uptake rates.
- A collaborative inter-specialty and multidisciplinary approach is essential for seizure care pathway implementation.
- We have formulated five SMART principals which can be used as a universal guide for clinicians

PurposeTo identify barriers to implementation of an evidence based integrated care pathway (ICP) for seizure management in the Emergency Department (ED).MethodsA site specific bespoke questionnaire was designed to solicit anonymous responses from all grades of ED medical and nursing staff to a series of questions regarding utility, feasibility, significance and implementation of a locally designed and championed ICP for seizure management and onward referral.ResultsWhile 95% of respondents agreed that the pathway ensured patients were treated according to best practice, a number of human factors were identified as barriers to use. These fell into three categories 1) environmental 2) pathway design/process and 3) user related issues.ConclusionsMost respondents understood and endorsed the evidence based utility of the pathway. Barriers to use, however, are broad with interactions involving many complex human factors. Nevertheless, solutions can be relatively easily formulated but departmental-wide effort is required to comprehensively address all issues.