Optimizing Patient Transfers for Continuous EEG Monitoring in a Large Interhospital System
Eugene Uh1, Thanh-Tu Nguyen2, Bahram Kazani3, Sergio Salazar-Marioni3, Sarah Hinds1, Huimahn Choi1
1The University of Texas Health Science Center At Houston, Division of Neurocritical Care, 2Houston Methodist Sugar Land Hospital, 3The University of Texas Health Science Center At Houston, Deaprtment of Neurology
Objective:
The objective of this study is to systematically identify patients who do not require transfer to a tertiary facility for continuous EEG monitoring.
Background:
40% of patients with status epilepticus are admitted to facilities without cEEG capability, leading to about 20% being transferred to tertiary facilities. These transfers can be resource-intensive, with many patients not receiving cEEG after evaluation. This study aims to identify and characterize patients transferred unnecessarily for cEEG to optimize transfer practices and reduce unnecessary costs.
Design/Methods:
retrospective chart review from July 2022 to February 2023. Data on 166 patients transferred from referring facility to tertiary facility for cEEG monitoring was collected. Data on demographics, medical history, clinical interventions, and EEG usage are collected and analyzed. The study uses descriptive statistics and univariate comparisons to assess transfer appropriateness
Results:
One referring facility accounted for 40% (n=64) of the transfers. The majority of the transferred patients (107 out of 166, or 65%) were admitted to the neuroscience intensive care unit. Among the patients, 58% (97/166) had a known history of seizures. Only 52% of the patients received cEEG, with just 11 (7%) showing status epilepticus on cEEG. Of the 48% (n=80) who did not undergo cEEG, 43 (54%) were admitted to the neuroscience intensive care unit. Notably, 70% (30/43) of these patients were transferred while intubated, and 46% had infection-related conditions, such as septic shock. The median length of stay for these patients was 3 days, with an average LOS of 4.4 days.
Conclusions:
A large number of patients were transferred without needing the cEEG they were sent for, and most did not have status epilepticus on cEEG. By utilizing better tools at the referring facilities to identify those truly needing cEEG, many of these transfers could be avoided. Further studies are needed to explore ways to optimize patient selection for transfer.
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