F16. Standardizing neonatal EEG report based on expert consensus report

Abstract

Introduction Continuous EEG monitoring provides valuable diagnostic and prognostic information for critically ill neonates that are at high risk of adverse neurological sequelae. The EEG of a developing brain is unique. The parameters used to monitor brain electrophysiological functions in neonates are different from fully mature brains. The EEG report should contain all these essential parameters. Consensus guidelines were published in 2013(1) to standardize the neonatal EEG reports for neurophysiologist, bedside physicians, and clinical researchers. In this study, we compared our neonatal EEG reports to consensus guidelines and attempted to modify it to include all clinically relevant information. Methods We retrospectively reviewed EEG reports of ten (10) neonates that underwent EEG monitoring at Duke Neonatal ICU from March 2017 to June 2017. We compared these reports to consensus guideline published in 2013. We then created a new standardized neonatal EEG report. It included all of the parameters suggested in the guidelines such as characteristics of background activity, awake and sleep state, normal graphoelements, EEG transient patterns and seizure burden. The updated EEG template was implemented in July 2017. We conducted another chart review from September 2017 to November 2017 for ten (10) more EEG reports. We compared the results of both chart reviews. Results From the consensus statement, we identified 20 parameters that were deemed essential for a neonatal EEG report The first chart review from March 2017 to June 2017 of ten patient suggested that majority of reports were inadequate or missing critical information. Out of 20 parameters, only three were regularly documented. After three months of implementing the updated EEG report, the quality of documentation improved. Out of 20 parameters, 18 were consistently documented (100%). One parameter was documented 80% of the time, and only one parameter was reported 20% of the time. Conclusion Our chart review suggested documentation for neonatal EEG reports was lagging behind what was recommended in the consensus report. We made a template in the electronic health record to include all of the important parameters suggested by ACNS guidelines. On a follow-up chart review we noted a marked improvement in our documentation of neonatal EEGs. The standardize EEG reports for neonates will improve patient care, caregiver communication, and future clinical research.The neonatal EEG template made can be used in other institutions to achieve similar results.