AUTHOR=Ward Jared , Green Adam , Cole Robert , Zarbiv Samson , Dumond Stanley , Clough Jessica , Rincon Fred 

TITLE=Implementation and impact of a point of care electroencephalography platform in a community hospital: a cohort study

JOURNAL=Frontiers in Digital Health

VOLUME=Volume 5 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2023.1035442

DOI=10.3389/fdgth.2023.1035442

ISSN=2673-253X

ABSTRACT=Objective: To determine the clinical and financial feasibility of implementing a poc-EEG system in a community hospital.
Design: Data from a prospective cohort displaying abnormal mentation concerning for NCSE or rhythmic movements due to potential underlying seizure necessitating EEG was collected and compared to a control group containing patient data from 2020.
Setting: A teaching community hospital with limited EEG support.
Patients: The study group consisted of patients requiring emergent EEG during hours when conventional EEG was unavailable. Control group is made up of patients who were emergently transferred for EEG during the historical period.
Interventions: Application and interpretation of Ceribell®, a poc-EEG system.
Measurement and Main Results: 88 patients were eligible with indications for poc-EEG including hyperkinetic movements post-cardiac arrest (19%), abnormal mentation after possible seizure (46%), and unresponsive patients with concern for NCSE (35%). A mean of 1.1 patients per month required transfer to a tertiary care center for continuous EEG. For the control period, a mean of 2 patients per month were transferred for EEG. Annually, we observed a decrease in the number of transferred patients in the post-implementation period by 10.8 (95% CI: -2.17-23.64, p=0.1).

Financial analysis of the control found the hospital system incurred a loss of $3,463.11 per patient transferred for an annual loss of $83,114.64. In the study group, this would compute to an annual loss of $45,713.05 for an overall decrease in amount lost of $37,401.59.

We compared amount lost per patient between historical controls and study patients. Implementation of poc-EEG resulted in a decrease in annual amount lost of $37,401.59 by avoidance of transfer fees. We calculated the amount gained per patient in the study group to be $13,936.44. To cover the cost of the poc-EEG system, 8.59 patients would need to avoid transfer annually.


Conclusion: A poc-EEG system can be implemented in a community hospital leading to a decrease in transfers. This decrease in transfers can cover the cost of implementing the poc-EEG system. The additional benefits include rapid appropriate treatment of seizures and avoidance of unnecessary treatment as well as negating transfer risk.