Stanley Dumond, MD
Resident Physician
Inspira Health, United States
Disclosure information not submitted.
Jessica Clough, n/a
EEG Technician
Inspira Health, United States
Disclosure information not submitted.
Robert Cole, MD
Attending
Cooper University Hospital, United States
Disclosure information not submitted.
Fred Rincon, MD, MS, FCCM
Attending
Cooper University Hospital
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Use of Ceribell EEG System in a community hospital: a financial and patient outcomes impact study
Introduction: Nonconvulsive status epilepticus (NCSE) is a challenging diagnosis due to lack of exam findings and access to technology; emergent electro-encephalography (EEG) is even challenging at tertiary centers with full neurology support. This leads to misdiagnosis, mistreatment, and unnecessary transfers, resulting in higher costs and no benefit to patients. Recent studies show success of point-of-care EEG (poc-EEG) to fill this gap.
HYPOTHESIS: We hypothesize a poc-EEG is safe to implement in a community hospital and results in less transfers and cost.
Methods: An inception cohort, at a community hospital with limited neurology support, prospectively identified patients with abnormal mentation concerning for NCSE necessitating EEG for management. The FDA-cleared Ceribell poc-EEG system, a 10-electrode device that uses raw EEG waveforms and artificial intelligence interpretation, was implemented. All cases were assessed for initial and follow-up EEG findings, treatment response, patient disposition, and reimbursements. For controls, we used historical patient data from fiscal-year FY2020.
Results: From January-June 2021, Ceribell poc-EEG was applied in 30 subjects. Eligible subjects included patients with hyperkinetic movements post-cardiac arrest (37%, n=11/30), patients with a history of seizures and/or witnessed seizure activity without return to baseline (37%, n=11/30), and all other unresponsive patients with concern for NCSE (27%, n=8/11). Roughly 17% (n=5/30) had seizure burden on poc-EEG and only 3% (n=1/30) had continuous seizure activity on follow-up EEG. Only 13% (n=4/30) required transfer, 0.7 transfers per month (4/6). Of the patients transferred, only 1 was transferred for continuous EEG, the other 3 had no-seizure burden on poc-EEG, or follow-up EEG, but required transfer for non-neurological reasons. In 2020, 41% (n=25/61) of patients were transferred with suspected NCSE or 2 transfers per month (25/12). The average cost of ground transport was $1,950 and the reimbursements ranged from $4,358-$69,884; the average reimbursement was $13,999.
Conclusions: A poc-EEG system can be implemented in a community hospital; we excluded significant seizure activity or NCSE in 83-97% of our inception cohort. Compared to the prior year, poc-EEG reduced unnecessary transfers with significant cost savings.