This a collaborative initiative between the Gold Coast Horizons team, Queensland Ambulance Service (QAS) and schools to provide an individualised ambulance management plan for young people with functional neurological disorders, including pseudo seizures. This means that when a young person has an episode at school or in the community that they can be taken home to recover rather than being brought to the emergency department, significantly reducing acute hospital usage in this cohort.
Functional neurological disorders are safe and do not require acute medical treatment. When episodes occur in the community, and the young person cannot be physically moved, the ambulance is generally required to take the young person to emergency to recover from the event. When acute emergency services are already under significant stress and demand, this is an added burden for services. The ambulance may be waiting to be seen (ramping) and then or held up in addressing acute emergency calls. The emergency service is also then required to provide resources for a non-acute issue, impacting their flow. Finally, the patient and family, who already understand the disorder and would like to go home, are impacted with prolonged time waiting for recovery and clearance in the hospital.
Individualised ambulance plans for young people with functional neurological disorders
Summary
Aim
The overarching goal was to provide patient and family centred care by reducing the impact of the functional neurological disorder and to reduce acute emergency service utilisation.
Benefits
For the young person and their family there have been numerous benefits including:
- reduced patient anxiety, and therefore events, having an established management plan
- improved earlier integration back to school due to improved school confidence in accepting a young person with functional neurological disorder
- reduced impact on family resources - young person back to school and parents can go to work
For the emergency and hospital services the benefits include:
- more efficient use of the ambulance service as they can take patient directly home
- reduced emergency department usage
- improved patient flow in the hospital
- reduced medicalisation of a mental health disorder
Background
The effects of recurrent pseudo seizures or dissociative (non-responsive) episodes can be debilitating for the young person and their family. Functional neurological disorders, however ,are safe and do not require acute medical treatment.
Solutions Implemented
The Horizons team is an outpatient multidisciplinary team that works with young people suffering from functional neurological disorders with a goal to diagnose, provide education and understanding of the disorder, and aim for full recovery with management of symptoms, and reintegration into normal life activities like school. Once diagnosis and education are complete, the Horizons team develop an individual management plan that supports the young person to manage symptoms. This includes an individual ambulance management plan. The plan provides a diagnosis, a description of a typical episode and management plan. The ambulance can take the young person directly home to recover in a familiar, calm environment. If the presentation does not fit the usual description, or there are acute medical concerns, normal emergency procedures are required.
Evaluation and Results
Once we developed an ambulance plan, we evaluated the number of ambulance calls that were required to take the young person home. These were counted as number of hospital avoidance episodes.
Since this approach has been implemented, we have saved 84 emergency presentations - which represents a significant cost saving to our service.
We also sort qualitative feedback from families and schools.
Families and young people reported increased confidence in going to school knowing a plan was in place. Schools were able to accept students back with functional disorders as there was a medically acceptable plan in place.
Lessons Learnt
It was easy to communicate and collaborate with QAS, ensuring high quality patient care. We were surprised at the willingness to change, to meet the need of patients, rather than just sticking to standard practices. The collaboration has improved relationships between the Horizons team, QAS and the emergency department resulting in further efficiency in care.
