An audit of first seizures presenting to an Accident and Emergency department

Objective: To investigate whether patients presenting after a first seizure to an Accident and Emergency (A&E) department were being managed according to consensus recommendations. Design: Retrospective audit. Setting: UK District General Hospital over 6 months. Methodology: Hand search of Accident and Emergency notes for diagnoses of "seizure";, "fit";, "epilepsy"; and "epileptic fit";, followed by scrutiny of hospital and General Practice (GP) medical notes. Results: Eighty three percent of patients discharged from the A&E department with a letter to take to their general practitioners, but only 20% of those referred directly to the neurology clinic, were lost to follow-up. Of the patients seen as out-patients by a neurologist, the median waiting time to clinic was 22 weeks, 18 weeks longer than recommended. The average time to having an MRI scan and EEG performed were 12 and 15 weeks, respectively. Twenty percent of patients seen by a neurologist were not felt to need further investigation for epilepsy. Conclusions and recommendations: All patients presenting after a first seizure should be directly referred to a neurology clinic from the A&E department. The currently proposed target time to specialist review is unrealistic without significant resource improvements. The provision of diagnostic guidelines and telephone advice by the neurology team prior to discharge from A&E may avoid unnecessary investigation.