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Integration of EEG Lead Placement Templates Into Traditional Technologist-Based Staffing Models Reduces Costs in Continuous Video-EEG Monitoring Service

Kolls, Brad J.*,†,‡; Lai, Amy H.*; Srinivas, Anang A.*; Reid, Robert R.*

Journal of Clinical Neurophysiology: June 2014 - Volume 31 - Issue 3 - p 187–193
doi: 10.1097/WNP.0000000000000053
Original Research

Pupose: The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application.

Methods: We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤24-hour duration, technologists for on-call studies, and technologists for all studies.

Results: Cost was linearly related to the study volume for all models with the “templates for all” model incurring the lowest cost. The “technologists for all” model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current “technologist for all” model.

Conclusions: Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

*The Fuqua School of Business, Duke University, Durham, North Carolina, U.S.A.;

Department of Neurology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, U.S.A.; and

Brain Injury Translational Research Center, Durham, North Carolina, U.S.A.

Address correspondence and reprint requests to Brad J. Kolls, MD, PhD, 421 Research Drive, Bryan Research Building, 227F, Duke University Medical Center 2900 Durham, North Carolina, U.S.A.

© 2014 by the American Clinical Neurophysiology Society