EEG Monitoring Workflow and Resource Utilization: A Survey of Current Practices in the United States
Abstract number :
2.125
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2024
Submission ID :
458
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Ahmad Mahadeen, MD – University of Mississippi Medical Center
Sahar Zafar, M.D., MSc – Massachusetts General Hospital
Olga Selioutski, DO – University of Mississippi
Olga Taraschenko, MD, PhD – University of Nebraska Medical Center
Susan Herman, MD – Barrows Neurological Institute
Suzette LaRoche, MD – University of North Carolina Chapel Hill
Hiba Haider, MD – University of Chicago Medicine
Eva Ritzl, MD – Mass General Brigham
Rationale: Recently published Guidelines for Specialized Epilepsy Centers (Lado et al, 2024) provides detailed guidance on Epilepsy Monitoring Unit (EMU) operations. Standards for continuous video-EEG (cvEEG) monitoring operations are not available, despite its heavily expanded use in the past decade. This survey aimed to assess the resources and the workflow of EMU and cvEEG monitoring services.
Methods: In this IRB-approved project, an 80-question survey was designed and disseminated via REDCap to directors of epilepsy centers, whose emails were obtained from the National Association of Epilepsy Centers (NAEC) Board.
Results: The response rate was 12.7 % (42/331); 34 (81%) and 3 (7%) were from Level 4 and Level 3 NAEC accredited Epilepsy Centers respectively. Three (7%) centers did not have NAEC accreditation. Two respondents did not specify their designation. Among these, 23 were Adult only, 8 were Pediatric only, and 11 were combined programs. All centers offered cvEEG services for non-EMU patients.
During the daytime 22 centers had a single attending responsible for EMU and cvEEG coverage, while 19 had separate attendings covering each service during the day. Afterhours, 35 centers had one attending covering both services, and only 4 had separate attendings covering overnight studies.
Live monitoring of patients in both cvEEG and EMU services was performed by the same personnel in 28 centers; 23 centers utilized Neurodiagnostic Assistants (NDAs) and 29 utilized Neurodiagnostic Technologists (NDTs) for live monitoring. In 28 centers the initial review of cvEEG occurred in real time by NDTs.
Out of 41 responders, afterhours EEG reviews were done by the Epilepsy attendings in 31; CNP/Epilepsy fellows in 22, neurology residents in 14 and general neurology attending in 8 centers. Only 2 centers had NeuroICU attendings/fellows reviewing cvEEG after hours.
In general, cvEEG was reviewed by NDTs in only 21 centers. In 36 centers physicians reviewing cvEEG were attendings, in 22 CNP/Epilepsy fellows, in 7 residents and in only 1 review was done by the Critical care fellows. Three centers outsourced cvEEG reviews to the outside company altogether. In only 6 centers NDTs participated in writing the report, while 11 involved residents, and 23 involved fellows. Most (40) centers utilized standardized ACNS terminology for ICU EEG reports. cvEEG initiation was available 24/7 in 29 centers. qEEG was used by EEG clinician readers in 28 centers, not used at all in 8, and was used by the NDTs in only 1 center.
Ten centers had alternative EEG acquisition systems 4 used EEG cap and 6 had Rapid EEG. Trainees were responsible for application of these systems in 6, attendings in 2, nurses in 3, APPs in 1 and NDTs in 1 center. Three centers only used this after hours, while 3 centers had this modality available at any time.
Out of 26 centers, 5 reported neuro-ICU attendings were consistently reviewing cvEEG, in 15 they rarely did so and in 5 they relied on the epilepsy team to provide the report.
Conclusions: There is considerable variability among epilepsy centers in their approach to delivering cvEEG services Standardization of these practices is desirable.
Funding: None
Neurophysiology