Authors :
Presenting Author: Stephen Lee, MD – University of Chicago
Jacob Carolan, MD – University of Chicago
Tamera Taylor, R.EEGT – University of Chicago
Hiba Haider, MD – Department of Neurology, University of Chicago, IL
Rationale:
Stat-EEG is typically indicated in cases of unexplained altered consciousness where Nonconvulsive Status Epilepticus (NCSE) is suspected, as per ACNS Guidelines.1 However, overuse of Stat EEGs can overburden neurodiagnostic teams and compounds delays for more EEGs. Downstream, this negatively impacts care delivery and potentially delays patient disposition. We aimed to identify key drivers of EEG Turnaround Time as well as study clinical risk factors that can lead to a change in medical management based on EEG. Methods:
We conducted a retrospective analysis of inpatient EEGs completed at the University of Chicago Medical Center – a Level 1 Trauma Center - over a 2.5 month period. This was a quality improvement study. We assessed time to EEG placement, indications & risk factors, and the impact of the EEG on medical management and disposition (to inpatient vs discharge from the ED). Additionally, EEG technologist staff were surveyed anonymously to assess the barriers to EEG placement.
Results:
35% of all EEGs during the study period were ordered as Stat priority, of which a convenience sample of 110 EEGs (80 inpatient, 30 ED) were further analyzed. The presence of two or more clinical seizure risk factors was associated with a change in management due to EEG findings. For patients who had an EEG started in the ED (n=30), 33% did not result in a change management, and in 53%, EEG findings did not change disposition. 40% of patients whose EEGs were initiated in the ED were at their baseline mental status at the time of EEG order, which increased to 46.7% by the time EEG placement was completed. Median length of stay for ED patients who had an EEG and were subsequently able to be discharged home was 15.1 hours, compared to 12.4 hours for patients who were ultimately admitted to an inpatient service.
The EEG Technologist survey ranked competing medical care needs (e.g., scans, other procedures, etc.) as the most significant factor in delayed EEG placement in both the ED and inpatient setting. EEG Techs perceived an overuse of Stat EEG priority more frequently in the ED; whereas, insufficient EEG technician staffing was ranked higher in the inpatient setting.
Conclusions:
Overutilization of Stat orders impacts turnaround times for other EEGs. In our cohort, we found that Stat EEG was unlikely to change management in patients who were at their neurologic baseline at the time of EEG placement and had one or fewer seizure risk factors. This data will be used to define criteria that warrant a Stat EEG as well as the basis for a clinical pathway to divert selected patients for urgent outpatient EEGs.Funding: No funding was received