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Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

Publication ,  Journal Article
Kolls, BJ; Mace, BE; Dombrowski, KE
Published in: Neurocrit Care
April 2018

BACKGROUND: Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. METHODS: We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. RESULTS: Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. CONCLUSION: ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced transfers. The system allowed for successful management of ICU patients with underlying seizures and eliminated interfacility transfers, producing a savings of $145,750. The savings combined with the retained patient revenue produced a total revenue of over $250,000 with additional revenue in professional services as well. These results suggest expansion of cvEEG monitoring to community ICUs is practical, financially sustainable, improves the level and quality of care, and reduces costs.

Duke Scholars

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

April 2018

Volume

28

Issue

2

Start / End Page

229 / 238

Location

United States

Related Subject Headings

  • Video Recording
  • Seizures
  • Procedures and Techniques Utilization
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Intensive Care Units
  • Humans
  • Hospitals, Community
  • Feasibility Studies
 

Citation

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Kolls, B. J., Mace, B. E., & Dombrowski, K. E. (2018). Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs. Neurocrit Care, 28(2), 229–238. https://doi.org/10.1007/s12028-017-0468-6
Kolls, Brad J., Brian E. Mace, and Keith E. Dombrowski. “Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.Neurocrit Care 28, no. 2 (April 2018): 229–38. https://doi.org/10.1007/s12028-017-0468-6.
Kolls, Brad J., et al. “Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.Neurocrit Care, vol. 28, no. 2, Apr. 2018, pp. 229–38. Pubmed, doi:10.1007/s12028-017-0468-6.
Kolls BJ, Mace BE, Dombrowski KE. Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs. Neurocrit Care. 2018 Apr;28(2):229–238.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

April 2018

Volume

28

Issue

2

Start / End Page

229 / 238

Location

United States

Related Subject Headings

  • Video Recording
  • Seizures
  • Procedures and Techniques Utilization
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Intensive Care Units
  • Humans
  • Hospitals, Community
  • Feasibility Studies