Abstract Details

Title A Quality Improvement Project Studying the Integration of a Proposed Diagnostic Algorithm on Inpatient Encephalitis into the Electronic Medical Record and its Impact on Length of Hospital Stay

Topic Infectious Disease

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-023

Objective To establish and study a diagnostic algorithm and inpatient order set for improved evaluation of suspected encephalitis on the neurology inpatient service.

Background

Encephalitis is a complex and challenging neurologic disease. Over one hundred viruses can cause encephalitis, along with more newly recognized autoimmune and paraneoplastic etiologies. Given the high morbidity and mortality associated with encephalitis, rapid and accurate diagnosis is important.

Design/Methods We developed a diagnostic algorithm that incorporates CSF and serum testing, MRI findings, travel exposure, seasonality, immunological status, and clinical factors to streamline diagnostic testing in an efficient manner. We built the inpatient diagnostic order set into the EMR and provided educational training to the Neurology Department. The primary outcome measure of this interim analysis was clinical length of stay.

Results

113 patients with encephalitis were identified in this non-implementation patient set with an average clinical length of stay of 26.4 days with a median length of stay of 14.9 days. As of this interim analysis, the order set was used 40 times since it was implemented over a 6 month time period. Of these patients, 15 (35%) had a primary ICD-10 diagnosis associated with encephalitis at the time of discharge. The average clinical length of stay for this patient set was 12.3 days (p value 0.098) with a median length of stay of 4.6 days (p value .0058).

Conclusions

This interim analysis demonstrates a statistically significant decrease in the median clinical length of stay (10.3 less days, p value 0.0058). There was also an observed decrease in the average clinical length of stay (14.1 less days), however not statistically significant at the time of this interim analysis due to the number of cases utilizing the order set. There will be ongoing analysis over the next 6 months.

Authors/Disclosures
Tyler Kaplan, MD (Rush MS Center) PRESENTER	Dr. Kaplan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono . Dr. Kaplan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Octave Biosciences. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Kaplan has received personal compensation in the range of $100,000-$499,999 for serving as a Speaker with EMD Serono. Dr. Kaplan has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with Amgen. Dr. Kaplan has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with TG Therapeutis. Dr. Kaplan has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with Biogen.
	No disclosure on file
Jonathan R. Galli, MD (University of Utah)	Dr. Galli has nothing to disclose.
Tracey Cho, MD, FAAN	Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyverna. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care.
Stacey Clardy, MD, PhD, FAAN (University of Utah)	Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.
Amanda L. Piquet, MD, FAAN (University of Colorado)	The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech/Roche. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kyverna . The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech/Roche. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Joe Jones Law Firm. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Cortez & Associates. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Falk Waas. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. The institution of Dr. Piquet has received research support from Anokion. The institution of Dr. Piquet has received research support from UCB . The institution of Dr. Piquet has received research support from Foundation for Sarcoidosis. The institution of Dr. Piquet has received research support from Kyverna . Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Autoimmune Encephalitis Alliance (AEA) that is relevant to AAN interests or activities. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Stiff Person Syndrome Research Foundation (SPSRF) that is relevant to AAN interests or activities.

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