Outcomes In Perspective
A newsletter for the physicians of Tampa General Hospital
Volume 9—Number 10
July 2008
THE USE AND ABUSE
OF STAT EEG
Selim R. Benbadis, MD
Professor and Director,
Comprehensive Epilepsy Program [http://epilepsy.usf.edu]
Departments of Neurology & Neurosurgery
University of South Florida and Tampa General Hospital
sbenbadi@health.usf.edu
Excerpts from the full article in press [Expert Review
of Neurotherapeutics, 2008].
INTRODUCTION
Stat testing is unquestionably inherent to medicine, and is frequently discussed in the laboratory medicine literature. The issue stat EEGs is a thorny one for every EEG laboratory. Referral tertiary centers should (and
do) offer EEGs 24 hours a day and stat, but this requires certain rules and procedures.
DEFINITION OF “STAT”
Stat is the highest degree of medical priority. Whether it is for a test, a procedure, or a consultation, stat
means that it is a medically emergency, i.e., the result will affect immediate management and eventual outcome. In order to be executed, the staff and physician involved must interrupt what they are doing to perform
the procedure immediately, regardless of the time and day. This of course includes after hours (night, weekends), and if requested during regular hours, stat procedures should be done immediately, “bumping” other
procedures that are not stat.
THE PROBLEM
In general terms, the abuse of stat tests has several undesirable consequences, including:
>Poor use of time and resources to the detriment of patients who really need emergency procedures. This increases the turnaround time of non-stat procedures, and may result in clinicians ordering more stats in order to
get results more rapidly, thus creating a vicious cycle.
>Staffing difficulties and increasing the use of overtime.
>Frustration and strain of staff and physicians.
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Outcomes In Perspective
THE USE AND ABUSE OF STAT EEG
A stat EEG is not like a stat CBC!
In addition to these general side effects, there are additional issues specific to EEGs.
>For some procedure, the stat attribute makes little difference because the personnel is available in house 24 hours a
day and the procedure available within minutes (e.g., blood count, EKG, chest X-ray). For others like EEG, however, stat
means that personnel and physicians have to make the trip to the hospital, and realistically the test is available within a
few hours at best.
>In regards to EEG, stat means that the EEG to be performed and interpreted emergently, i.e., the technologist comes in
to perform the study and the neurologist comes in to read it.
INDICATIONS (AND NON-INDICATIONS) FOR STAT EEGS
Non obvious status epilepticus
The only legitimate and universally accepted indication for a stat EEG is to evaluate the possibility of non-convulsive
(non-obvious) status epilepticus (NCSE). To justify a stat EEG, there should be a reasonable suspicion for NCSE, i.e.,
not every unresponsive patient should be suspected of being in non-convulsive status. A reasonable suspicion is of
course a matter of clinical judgment, but for example a patient whose “mental status changes” are readily explainable
(e.g., SAH, ICH, illicit drugs, hyponatremia), does not justify a stat EEG “just to make sure.”
Obvious seizure or status
There is no need for a stat EEG following a single seizure that has stopped. Similarly, overt (convulsive) status epilepticus is not an indication for stat EEG. What it needs is stat treatment. An EEG may be warranted at a later point, but not
stat.
Brain death
In general, EEG for the confirmation of brain death should not be an emergency. It is often necessary to emphasize the
fact that brain death is a clinical diagnosis that does not require EEG.
Impending discharge
Generally, discharging a patient should not have to wait for the result of a routine EEG.
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Outcomes In Perspective
THE USE AND ABUSE OF STAT EEG
CONCLUSIONS AND RECOMMENDATIONS
Based on our experience and an informal survey of other referral epilepsy centers and EEG laboratories, the
following recommendations allow offering the service of stat EEGs while making it workable:
>EEG orders should be divided into 3 categories:
>Routine: next available on schedule.
>Stat: available anytime any day. Should be performed within 2-4 hours and interpreted 2-4 hours after that.
>ASAP: this intermediary status is useful and highly recommended, because many EEGs that are not
stat should also not wait 1-2 days. With this, many “pseudo-stats” can be downgraded to ASAP.
>Stat EEGs should only be ordered by Neurologists. Any situation requiring a stat EEG should require a Neurology consultation.
ANNUAL TGH MEDICAL STAFF MEETING
Tuesday, September 16, 2008.
—————
State Licensure courses offered at 11:00 AM:
HIV/AIDS—Domestic Violence—Medical Errors
Also offered: Documentation for Severity of Illness
—————
Annual Meeting begins at 6:00 PM:
Officer Election
Guest Speaker: Story Musgrave, M.D.
Surprise Door Prizes
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Tampa, FL
Permit No. 228
Tampa General Hospital
Quality Improvement Department
P. O. Box 1289
Tampa, FL 33601
WE’RE ON THE WEB
W W W . T G H . O RG
The physicians below were added to TGH staff May 31st.
Clifford L. Davis, M.D.
Clifton L. Gooch, M.D.
David Leffers, M.D.
Kamal Massis, M.D.
Radiology & Nuclear Medicine
Neurology
Orthopaedic Surgery
Radiology & Nuclear Medicine
This newsletter is produced by
Tampa General Hospital’s
Quality Improvement
Department.
All comments, responses or suggestions are welcome and should be
directed to:
Sally H. Houston, M.D.
Sr. V.P. &
Chief Medical Officer
Tampa General Hospital,
P.O. Box 1289,
Tampa, Florida 33601
~~~~~~~~~~
Physician Kudos….
Congratulations to the following physicians who
were recognized by their patients in the form of a
personal letter to TGH leadership.
Editorial Review Board
EXECUTIVE EDITOR
Sally H Houston, M.D.
EDITOR-IN-CHIEF
Dr. James Norman
Dr. David Ciesla
Dr. Suneel Khetarpal
Charles F. Bombard, RN, MHA
LAYOUT & DESIGN
Paul DeLand
BOARD MEMBERS
Deana Nelson, RN, MHA
Devanand Mangar, M.D.