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Title: Care pathway for suspected seizures in the Emergency Department : an in-depth exploration
Author: Burton, Leanne
ISNI:       0000 0004 9358 6695
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2020
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Background: Seizures due to epilepsy, or other conditions, result in ~60,000 emergency department (ED) attendances in England each year. Most are made by people with established epilepsy who represent a particularly vulnerable part of the epilepsy population. The UK's National Audit for Seizure Management in Hospitals (NASH) identified wide geographical variation in the standard of care people receive for seizures in ED. Seizure care in the ED and through to tertiary services is complex. In Mersey and Cheshire, a seizure care pathway was developed to improve the management of seizure patients. To date, little is known about the views of patients' experiencing the care pathway, those delivering its care, and the best way to audit this. This thesis aims to explore patients' and professionals' perspectives of the seizure care pathway and develop a patient-reported experience measure (PREM) to audit the pathway. Methods: This qualitative evaluation project consisted of three inter-related studies. A systematic review was conducted to identify and evaluate currently available patient-reported experience measures (PREMs), as audit tools, for use specifically within the ED. Subsequently, two qualitative studies, using semi-structured interviews, were conducted to explore the experiences of people with seizures receiving care in the ED (n=27) and professionals delivering it (n=6). Participants were purposively sampled from three NHS hospital sites who were delivering the seizure care pathway. Interviews were recorded, transcribed verbatim and transcripts analysed thematically. Findings: The systematic review revealed four previously designed PREMs for use within the ED population, but were not disease-specific to epilepsy. There was significant variation in the psychometric development of these PREMs. Scoping literature review identified few studies that assessed the experience of patients with epilepsy when presenting at the ED and in neurology services. The subsequent qualitative study with seizure patients sought to address this knowledge gap. Discontinuity in care, waiting and poor communication were elicited as some of the most important findings. A lack of memory of ED experience was explored and became a key finding of many interviews. This led to a reconsideration around the validity of developing a PREM for this population and from this point the scope of the thesis altered. Professionals' perspectives were explored and led to similar findings to patients, particularly in the lack of care continuity from ED onto neurology services. Conclusion: This study provides a unique contribution to the literature on health care experiences of patients presenting to the ED following a seizure. Patient data identified potential gaps in ED care and subsequent follow-up services. Heath care professional data highlighted various operational barriers resulting in lack of consistency in the care. Clinical recommendations and future research suggestions have been made to develop and improve the care pathway, as well as the clinical environment and management of seizure patients along the seizure care pathway continuum.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral