The Arthur M. Blank emergency department, part of Children’s Healthcare of Atlanta, worked to address delays in second-line antiepileptic administration for patients in status epilepticus.

Children’s Healthcare of Atlanta at Arthur M. Blank Campus Emergency Department

Although evidence recommends starting second-line therapy within 20 minutes of first-line benzodiazepines, almost half of cases were experiencing delays in therapy. Interventions included re-educating teams, revising the order set to allow simultaneous ordering of first- and second-line drugs and designating levetiracetam as the preferred second-line agent for easier pharmacy preparation. After a concentrated levetiracetam formulation became available, it was stocked in the ED for nurse preparation and delays dropped to 13 percent of cases, exceeding the goal of 20 percent.

The 75-bed ED, which saw almost 91,000 patient visits in 2025, also made substantial efforts to reduce nursing staff turnover and improve satisfaction and retention. The team expanded senior scheduling options, previously limited to nurses with five years of service, to those with one and three years of experience, too. ED nurses also now earn a critical care differential, which increases with years of experience. Lastly, an onboarding specialist role was created to support new ED nurses, working with educators and preceptors to provide individualized training and support for the first year of hire. Nursing retention consequently rose from 74 percent in 2022 to 87percent in 2025.