|Funding||European Commission for health and food safety|
Epilepsy is common, and for those with an established diagnosis each presentation to an emergency department (ED) represents a “failure” in control. Also, those presenting with a first seizure require appropriate acute management and rapid access to seizures services. Ascertaining patients presenting to ED provides an opportunity to assess their acute care as well as their prior and onward care.
Whilst there are many research studies in epilepsy assessing the best treatment options for patients with epilepsy, little attention has been paid to assessing the organisation and delivery of epilepsy care at regional and national levels. In the UK, the National Audit of Seizure management in Hospitals (NASH) has had two rounds of data collection and analysis. Anonymous data have been collected on almost 9000 ED attendances from over 150 hospitals. Whilst some units were able to provide consistently good care given current resources, the audit identified unacceptable variation in the quality of care. The results have led to the prioritisation of epilepsy care by the NHS lead for neurological conditions, and a number of local project are underway to improve care pathways (http://www.hra.nhs.uk/news/research-summaries/care-after-presenting-with-seizures-caps/).
National and international audits can change care and practice. Previous experience of the study team in national audits of myocardial infarction, stroke, carotid endarterectomy, evidence-based prescribing, COPD, lung cancer, continence, inflammatory bowel disease, blood transfusion, and palliative care have shown them to be successful in improving services as the results have been fed back to sites. There has been similar success with a European COPD audit (http://www.ersnet.org/eu-activities/ers-funded-projects/item/4387-ers-copd-audit.html).
The European Union has funded a programme of work: the European Study of Burden and Care in Epilepsy (ESBACE). One of the work packages is the EuropeaN Audit of Seizure management in Hospitals (EuroNASH), which will be undertaken in a number of European countries, with data collected from at least 5 hospitals per participating country. EuroNASH seeks to assess the feasibility of a future European-wide audit, and, for those hospitals that take part, will identify any variation in patient care and some of the resource and organisational factors that may account for this. The audit data will provide a first European benchmark against which clinical teams can compare themselves now, and monitor future change.