The electroencephalogram (EEG) can be a vital tool for monitoring a patient’s brain activity, especially related to detecting seizures. Beyond cases of epilepsy or consciousness disorders, EEG may be utilized to record brain function in the wake of a stroke, intracranial hemorrhage, brain tumors, encephalitis, traumatic brain injury, and even cardiac arrest.
Continuous EEG (cEEG) is the process of sustained monitoring, offering real-time insight to changes in the functional integrity of the brain. cEEG is considered best practice for patient management equipping treatment teams to reliably make better diagnostic and prognostic decisions. The use of cEEG in the ICU can be instrumental for determining care because many critically ill patients suffer from nonconvulsive or subclinical seizures, and delayed diagnosis can affect a patient’s prognosis or morbidity. Research shows that cEEG monitoring can improve outcomes, reduce length of stay, and decrease hospital transfers, enabling better continuity of care and retained revenue.
The Critical Role of cEEG in the ICU
In the ICU, cEEG can provide an essential window into a patient’s condition, revealing their response to treatment and the development of any complications from their illness or injuries. One of its key benefits is seizure detection. More than 80% of ICU seizures may be subclinical, and nonconvulsive seizures occur in 8-30% of patients with altered mental status.
Seizure activity can have long-term implications for the patient’s neurological health and recovery, so early detection provides a pathway for adjusting treatment and potentially preventing lasting neurological damage. The lack of a timely diagnosis can be costly for both patients and hospitals. In one case, a delayed diagnosis of nonconvulsive status epilepticus resulted in a $1.5 million legal judgment against a hospital because the patient had suffered long-term cognitive impairment.
In the NICU, cEEG is the gold standard for neonatal seizure detection. It can predict seizure risk in neonates, be used in the differential diagnosis of paroxysmal events, and identify responses to treatment. Additionally, cEEG can be implemented to evaluate hypoxic encephalopathy severity, assess hypotonia, and monitor infants who may be at greater risk of brain injury.
How cEEG Improves Outcomes and ICU Care
What’s the explicit value of cEEG? Even routine EEGs can miss intermittent seizure activity — approximately 50% of epileptic patients have abnormalities that regular EEGs don’t catch. Time-to-diagnosis is precious for critically ill patients or NICU babies, so early detection of seizures or complications can mean a shorter length of stay, reduced medication exposure, and decreased risk of neurological damage from ongoing seizure activity. In one case study, a cEEG-based neonatal status epilepticus protocol led to a lower seizure burden, decreasing length of stay by nearly 10 days.
Moreover, cEEG offers data on a patient’s response to treatment, which is especially vital when patients are nonresponsive or comatose. Continuous EEG can monitor sedation, help characterize movement disorders, identify vasospasm and ischemia risk, and allow for more accurate neuroprognostication. When clinicians have more data on a patient’s condition, they can make more informed decisions about care in a timely manner. With cEEG, ICU patients can benefit from improved neurological outcomes and experience better rates of survival.
The Operational and Financial Impact of cEEG
The use of cEEG has an impact on a hospital’s bottom line. In addition to reducing the risk of delayed diagnoses, cEEG can decrease the incidence of interhospital transfers. It allows hospitals to retain their patients locally while expanding ICU capabilities. According to the National Institutes of Health, only 27% of hospitals were EEG capable as of 2023. Providing EEG and cEEG monitoring can help providers stand out and maintain continuity of care, retaining income and building a stronger reputation in the community.
Patients with epilepsy are more likely to be transferred than other types of patients. According to the American Academy of Neurology (AAN), 20% of emergency department patients with status epilepticus were transferred, and 5% of hospitalized status epilepticus patients were transferred, compared with only 1.5% of the general hospitalized population.
Limited EEG access can be tied directly to poorer outcomes and lost hospital revenue. In a case study of a community hospital that utilized adult cEEG monitoring in the ICU over three years, seizures were identified in 27% of monitored patients, and 94% of status status epilepticus patients were successfully treated. Because of cEEG monitoring, 53 patients were retained instead of transferred, saving an estimated $145,750, with a total revenue impact of over a quarter million dollars with professional services as well.
Partner with SpecialtyCare for Comprehensive EEG Solutions
If you want to retain revenue and improve outcomes with expanded EEG capabilities, SpecialtyCare can help. We support over 15,000 neurodiagnostic procedures every year across the country. We can place our EEG technologists on-site in ICUs, EDs, EMUs, and even outpatient clinics, in addition to providing remote monitoring support. Our fellowship-trained neurologists are skilled at rapid interpretation of EEG results, and our team members integrate seamlessly into your hospital’s workflow. We implement EEG technology to help you shorten time to treatment, reduce the number of orders for inappropriate tests, and minimize overtreatment. With scalable, turnkey EGG solutions, we help healthcare systems improve outcomes while managing costs. Get in touch with us today to learn more!
