Improved access to rapid electroencephalography at a community hospital reduces inter‐hospital transfers for suspected non‐convulsive seizures

Abstract

AbstractObjective. Patients with suspected non‐convulsive seizures are optimally evaluated with EEG. However, limited EEG infrastructure at community hospitals often necessitates transfer for long‐term EEG monitoring (LTM). Novel point‐of‐care EEG systems could expedite management of nonconvulsive seizures and reduce unnecessary transfers. We aimed to describe the impact of rapid access to EEG using a novel EEG device with remote expert interpretation (tele‐EEG) on rates of transfer for LTM.Methods. We retrospectively identified a cohort of patients who underwent Rapid‐EEG (Ceribell Inc., Mountain View, CA) monitoring as part of a new standard‐of‐care at a community hospital. Rapid‐EEGs were initially reviewed on‐site by a community hospital neurologist before transitioning to tele‐EEG review by epileptologists at an affiliated academic hospital. We compared the rate of transfer for LTM after Rapid‐EEG/tele‐EEG implementation to the expected rate if rapid access to EEG was unavailable.Results. Seventy‐four patients underwent a total of 118 Rapid‐EEG studies (10 with seizure, 18 with highly epileptiform patterns, 90 with slow/normal activity). Eighty‐one studies (69%), including 9 of 10 studies that detected seizures, occurred after‐hours when EEG was previously unavailable. Based on historical practice patterns, we estimated that Rapid‐EEG potentially obviated transfer for LTM in 31 of 33 patients (94%); both completed transfers occurred before the transition to tele‐EEG review.Significance. Rapid access to EEG led to the detection of seizures that would otherwise have been missed and reduced inter‐hospital transfers for LTM. We estimate that the reduction in inter‐hospital transportation costs alone would be in excess of $39,000 ($1,274 per patient). Point‐of‐care EEG systems may support a hub‐and‐spoke model for managing non‐convulsive seizures (similar to that utilized in this study and analogous to existing acute stroke infrastructures), with increased EEG capacity at community hospitals and tele‐EEG interpretation by specialists at academic hospitals that can accept transfers for LTM.