DOI: 10.1097/01.ccm.0000458040.71622.53

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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543: NEUROTELEMETRY

William Coplin; Patricia Santos; Tim Innes; Julie Rojas; Brad Westcott; Kathryn Polovitz

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Author Information: Centura Health, Englewood, CO

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Excerpt

Learning Objectives: It is now possible to monitor continuous digital continuous electroencephalography (cEEG) of many critically ill patients simultaneously, providing dynamic information and early detection of changes in neurologic status. Seizure burden of only 10 minutes in any hour of all cEEG monitored hours has been shown to cause neurological deficits. Survival rate of ICU patients on cEEG versus routine EEG 1s higher (33% vs 25%) We present an overview of a comprehensive remote neurocritical care cEEG monitoring program across a hospital network of 15 acute care facilities.
Methods: Demographic/Clinical Needs: shortage of Neurologists and EEG technologists, with a burgeoning neurocritical care patient population Implementation Issues: Neurologists include both employed and private practice. Inpatient EEG reading coverage needs 24/7 on-call rotation. Technologists work for hospital and not physicians that order test. Need continuous monitoring to be effective. Overcome inertia of status quo of continuous recording vs continuous monitoring for real-time intervention. Multi-departmental and multi-disciplinary communication requires sophisticated internal IT resources to link physician readers to bedside and other physicians. Consistent high patient volume justifies single hospital resources. Financial considerations: tech numbers and salaries, video EEG equipment cost – reimbursement outpaces costs at 1.5–2 patients/day. Options to cover 24/7 cEEG: 1) In-House program – complicated in hospital network with differing requirements, ICU capabilities, and patient severity, 2) Outsource monitoring and reading, or 3) Hybrid –outsource monitoring for gap coverage of in-house services for monitoring and/or physician interpreters and readers
Results: 1. Developing – in early stage 2. Monitoring from anywhere (with HIPAA considerations), including inflight 3. 4/15 hospitals up and running so far
Conclusions: The program appears complex but is feasible and has already yielded clinical benefits to patient care where growing patient volume exceeds physician and technologist resources.
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