Second NASH audit shows improvements needed across the UK for better epilepsy care in hospitals

Each year there are approximately 40,000 adult epilepsy related hospital admissions across the UK and an estimated 60,000 additional attendances at emergency departments. A 2004 review (Pugliatti et al, 2007) estimates that yearly epilepsy costs the UK £1.5 billion, yet there is no UK wide strategic plan for epilepsy services to help reduce hospital attendances, improve patient’s seizure control and reduce the public health burden of the condition. 

Back in 2011, the first National Audit of Seizure management in Hospitals (NASH) was conducted to assess the prior care, management and follow up of adult patients attending hospital following an epileptic seizure. The management of this care across the UK was previously unknown and this audit shed light on this area of care, highlighting that:

• over half of patients with uncontrolled epilepsy were not being seen within an epilepsy service
• assessment is often inadequate
• referral and access to services after presentation is poor

The audit was repeated in 2013 to re-assess the care delivered to those with epilepsy attending hospital and set out options for improving care in future. 154 hospitals took part in the audit, supplying data from 4544 seizure-related hospital attendances. The audit found that:

• 18% of those who attended hospital and had epilepsy were on no antiepileptic medication; with 63% showing no contact with epilepsy specialists in the year prior to their hospital attendance. 
• Hospital assessments were often incomplete.
• 75% of cases involving those experiencing first-seizures considered witness histories of the patient; with 58% being seen by a senior doctor and 57% of first-seizure patients then being admitted.  
• Only 27% of these first-seizure cases were given seizure management advice should they have subsequent seizures, with just over half (55%) being referred to a neurologist or epilepsy specialist. 

The second  audit shows many parallels with its previous audit, highlighting varied levels of care and methods of practice across the UK and only a slight improvement between the two audits. This variability has similarly been reported in hospital care for children with epilepsy through the Epilepsy12 audits. 

The audit calls for more to be done to help people with epilepsy manage their condition by having easier access to epilepsy specialists who can advise on seizure management, therefore lowering the overall hospital and ED admissions and lowering the cost of epilepsy on the NHS without compromising on patient safety. 

As stakeholders, SUDEP Action support this audit and encourages the Health Service to put steps in place to improve patient care, services and self-management in order to help keep people with epilepsy safe and lower the rates of potentially avoidable epilepsy deaths across the UK each year.  Jane Hanna, Chief Executive of SUDEP Action commented: “We support the conclusions of the audit. Risk continues to be underestimated with inadequate systems in place to ensure that people are getting the right advice and support to be safe in the community. We hope that with awareness of EpsMon and our SUDEP and Safety Checklist we will see an increasing number of professionals and people living with the condition addressing risk early on with a view to decreasing emergencies and epilepsy deaths in the community”  

This is why we have collaborated on projects such as EpSMon and the SUDEP and Seizure Safety Checklist, as well as working with other Epilepsy Charities and Neurological and Health Care bodies to create the Epilepsy Commissioning Toolkit. The implementation of such tools across General Practice and Neurological care is a step in the right direction to achieving this goal. 

Find out more about NASH here. 

To read the full report of the 2nd audit, click here.