February 2018 Spotlight
Stan Skinner, MD is a board certified neurologist and clinical neurophysiologist who has been involved in intraoperative neurophysiology (IOM) for 25 years. He obtained his medical degree from Washington University School of Medicine. He completed his neurology residency and clinical neurophysiology fellowship at the University of Minnesota. He is currently Director of Clinical Neurophysiology at Abbott Northwestern Hospital Minneapolis, MN. He is a Fellow of the American Clinical Neurophysiology Society (ACNS) and the American Society of Neurophysiological Monitoring (ASNM). Dr. Skinner is also an Associate Editor of the Journal of Clinical Monitoring and Computing. One of his leading societal missions has been advocacy for a patient centered model of IOM supervision. In the last several years, his primary research interests have been: the use of EMG in IOM, the application of Bayesian probability to investigate false reporting in IOM, the investigation of improved methods to monitor lower spine/pelvic surgery including autonomic neurophysiology, and the introduction of new options to explore and clarify the IOM evidence base.
In 2010 he was asked to draft a guideline for supervising IONM professionals (Skinner et al, 2014). As part of that work, he investigated the role of IONM physicians in the care of surgical patients. In 2011, CMS (Centers for Medicare and Medicaid Services) defined physician care in telemedicine, or so-called "remote monitoring". According to CMS, the continuous assessment of patients and the real-time communication of advice on patient care places all supervising IONM physicians, including those remotely connected, squarely in a consulting and co-practice role (Skinner, 2013).
This "co-practitioner" role is also supported by the more than 1200 articles on inter-professional communication in operating rooms. It turns out that poor communication is the key element in 2/3 of medical errors. The extensive scholarship on error avoidance and decision theory specific to ORs implies that IONM physicians should be encouraged to play a much more situationally aware and personal role during discussions of a possible change in case management after an IONM alert. That scholarship also includes clinical outcome studies showing a major reduction in poor outcomes when inter-collegial collaboration standards are improved in ORs. Obviously, the possibility of miscommunication and medical errors is increased if IONM physicians see themselves as something less than co-practitioners with the surgeon and anesthesiologist. The need to get all IONM physician to recognize their role in error reduction and patient safety led to this review.