Abstract
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.
Disclosure: Dr. Kaplan has nothing to disclose. Dr. Kresser has nothing to disclose. Dr. Galli has nothing to disclose. Dr. Cho has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Optum. Dr. Clardy has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Adivo Associates (<$1000, to University Development account). Dr. Clardy has received personal compensation in an editorial capacity for Neurology Podcast Section Editor. Dr. Piquet has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Sanofi Genzyme and honorarium from MedLink.
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