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Thursday, May 8, 2014

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Michael Ball

on 28 July 2016

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Transcript of Thursday, May 8, 2014

The University of Utah's Timeline
Then versus Now...
Statistics and Results
Thursday, May 8, 2014
Vol XCIII, No. 311
Clinical Neuroscience Center
University of Utah Medical Center
"If you build it, they will come"
Epilepsy Monitoring Unit
Mike Ball, R. EEG. T., CLTM, MBA
University of Utah Medical Center
Undergraduate: Behavioral Science/Health Promotion
Father of four, love road trips, Spare time = none
Senior Electroneurodiagnostic Technologist
Started in 2008, lead tech in 2010
Oversaw the implementation of EEG/ICU dept, Intracranial EEG testing and Long Term EEG Monitoring Unit
Why am I here?
Discuss recent changes in EEG testing
Detail specific changes made in Utah
Explore the possibility of an Epilepsy Monitoring Unit in Billings
476 beds
Over 1,000 board certified physicians
Over 200 specialties.
Physician Group
Board Certified Epileptologists (five)



Neurology Specialists
Nurse Practitioner

Outpatient clinic situated nearby in the Hospital
Long Term Monitoring Unit
4 Bed Long Term Monitoring Unit
ICU/Surgery Monitoring
Intracranial EEGs
Comprehensive Epilepsy Program
5 Full Time Technologist
Performing EEGs, Evoked Potentials and other procedures related to epilepsy diagnosis.
ABRET Certified Lab since 2010
Central Monitoring Station

24/7 Monitoring
Cortical Mapping
Resection Surgery
Intraoperative Monitoring
Motor mapping
5 IOM technologists
Necessary Costs
4. LAN access
3. Portable Machines
Level 3 EMU
Electroneurodiagnostic Services
1. Monitoring Unit
Monitoring Unit
Monitoring screens linked to machines
Hardwired Patient Rooms
Portable Acquisition Machines
Self contained unit
Up to 40 channels
Trending Software
Multiple modalities
Local Area Network
High speed network access
Electrodiagnostic EEG services including LTM

Epilepsy Surgery including VNS (routine lesional surgeries not requiring invasive monitoring

Neuroimaging, Neuropsychological, psychological services

Pharmacological expertise, Nursing support

Rehabilitation services (PT, OT, ST), Consult Services, Other
-National Association of Epilepsy Centers, 2013
2. Dedicated Rooms
Cost per machine $8-10,000
1 screen - 2 patients
Charting station
Total Cost $35-45,000 to start
Alarm relay
Acquisition machine mounted
Cost includes installation
Total Cost:
$60-75,000 per room
Cost per machine: $45,000
Trending Analysis Software : $8,000
At least 100 mg
better - 1 gb/sec
Large server
5 terabytes
15-25 gb.
Cost is variable
Break-Even Analysis
1 LTM Room,
2 ICU Portables,
LTM Monitoring Station
$25,000 IT
$45,000 supplies/other
4 Full time technologists - $23/hr - $192,000 annually
Variable expense
Reimbursement in Utah - $1800
National Ave - $2000
Epilepsy Monitoring Unit Timeline 2006 - 2014
Seizure Diagnosis
Seizure Classification
Medication Changes
Spot Inpatient for Status
In Addition to then...
Diagnostic Tool for Ischemic injury
Anoxic Brain Injury
Mental Status Changes
Intra-operative Monitoring
Cortical mapping
Equipment Limitations
No Video
Difficultly Remontaging
Relying on Technologist descriptions (eyes/ears of the physician)
No 24/7 remote access
Color video/audio
unlimited remontaging capability
Long term trending analysis
24/7 remote capability
Tech proof software
Staff limitations
No educational resources
High turnover of Staff
Impossible to Recruit
Difficult to Manage
Online Education
Increased opportunities
More available techs
Standards more established
OJT programs
Budgetary restrictions
Not much demand
Not much investment
Hospital Expense
Increased demand
Revenue generating unit
Wider scope
Greater investment
LAN Access
Local Area Network - >90% of Rooms
Purchased 3 ICU Portables
Implemented cEEG into Monitoring
Opened the Flood Gates
Allowed all ICUs to order cEEG
Limited gate-keeping by physicians
Marketed cEEG to the floors
Moved into expanded LTM Station
Large Scale Upgrades
Upgraded EEG software
Added 4 physician-dedicated review stations
Purchased additional Intracranial EEG equipment
Expanded Monitoring to another hospital
Purchased 2 more ICU machines
Keeping Pace...
Added Trending Analysis to cEEG
Increased benefited staff in LTM unit
Upgraded LTM rooms and server capacity
Job restructuring
Reducing expenses
1st LTM in Utah
3 dedicated beds
24/7 monitoring
Nurse staff - Night, EEG staff - Day
2 Portable Machines
4 Screen Monitoring Station
Expansion part 1
Monitoring control room
Added two screens
Addition portable machine
Began 24/7 coverage, all EEG staff
2006 - 129 cEEGs
557 LTMs

2010 - 478 cEEGs
1186 LTMs

2013 - 1179 cEEGs
1073 LTMs
Significant Investment to start
GUIDELINES FOR ESSENTIAL SERVICES, PERSONNEL, AND FACILITIES IN SPECIALIZED EPILEPSY CENTERS. (2010, January). National Association of Epilepsy Centers, (), . Retrieved from http://www.naec-epilepsy.org/spec_care/documents/NAEC-FinalGuidelineswithruralcenterrevision.pdf

Thomas, J., Curtis, C., & Adams, L. (2014, March). Indiana University Health Staffing Model for Neurotelemetry and Epilepsy Monitoring Unit Patient Populations: Parts 1 & 2. The Neurodiagnostic Journal, 54(1), 68-74.

LaRoche, S. M. (2013). Handbook of ICU EEG Monitoring. New York, New York: demosmedical.

American Epilepsy Society. (2013). Epilepsy Monitoring Units. Retrieved from https://www.aesnet.org/clinical_resources/epilepsy_monitoring_units
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