Quality standard
Quality statement 1: Referral to a specialist
Quality statement 1: Referral to a specialist
Quality statement
Adults presenting with a suspected seizure are seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Rationale
Diagnosing epilepsy can be complex, and it has been estimated that misdiagnosis occurs in 5–30% of people. It is therefore crucial that specialists are involved early in diagnosing epilepsy and that they take great care to establish the correct diagnosis.
Quality measure
Structure: Evidence of local arrangements for adults presenting with a suspected seizure to be seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Process:
a) Proportion of adults presenting with a suspected seizure who are seen by a specialist in the diagnosis and management of the epilepsies.
Numerator – the number of people in the denominator who are seen by a specialist in the diagnosis and management of the epilepsies.
Denominator – the number of adults presenting with a suspected seizure.
b) Proportion of adults presenting with a suspected seizure who are seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Numerator – the number of people in the denominator who are seen within 2 weeks of presentation.
Denominator – the number of adults presenting with a suspected seizure seen by a specialist in the diagnosis and management of the epilepsies.
Outcome:
a) Diagnosis of epilepsy that is subsequently found to be incorrect.
b) Diagnosis of a condition that is subsequently found to be epilepsy.
c) Number of adults with a recorded seizure type and/or syndrome.
What the quality statement means for each audience
Service providers ensure systems are in place for adults presenting with a suspected seizure to be seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Healthcare professionals ensure that adults presenting with a suspected seizure are seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Commissioners ensure they commission services for adults presenting with a suspected seizure to be seen by a specialist in the diagnosis and management of the epilepsies within 2 weeks of presentation.
Adults who have a suspected seizure are seen by a doctor with training and expertise in diagnosing and treating epilepsy within 2 weeks.
Source guidance
NICE clinical guideline 137 recommendations 1.4.5 (key priority for implementation), 1.4.1 and 1.4.2.
Data source
Structure: Local data collection.
Process: a) and b) Local data collection.
Outcome: a), b) and c) Local data collection.
Definitions
A suspected epileptic seizure is a reported acute episode of altered functioning, presumed to be the direct result of a change in electrical activity in the brain, the nature of which raises concerns that a seizure has occurred.
A specialist in the diagnosis and management of the epilepsies is a medical practitioner (a consultant neurologist or consultant with epilepsy expertise), who has epilepsy as a significant part of their workload (at least the equivalent of 1 session a week) with training and continuing education in epilepsy, usually working as part of a specialist epilepsy team.