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.