Abstracts

Rationale: At Mayo Clinic in Arizona (MCA), we are committed to improving health care in underserved populations throughout our state, through remote telemedicine consultation when appropriate. One challenge in the area of teleneurology is the need for urgent EEGs to facilitate appropriate clinical decision-making. While larger metro hospitals have on-call technologists with extensive training in EEG set-up, monitoring, troubleshooting and interpretation, the supply of such technologists is much too small to staff hospitals in remote areas. This project was designed to determine if the quality of EEGs obtained by non-specialized technicians (respiratory technicians) at a remote hospital could be improved significantly after an intensive, one-day training course. Methods: Respiratory technicians from a rural Arizona hospital (Kingman Regional Medical Center) were trained in the fundamentals of EEG setup and recording in a one-day session at MCA. Prior to this training, they had been applying electrodes using a template system (BraiNet ®), following only vendor-specific instructions. Afterward, they applied surface electrodes using systematic measurements according to the international 10-20 system. EEGs recorded either before or after training were reviewed in a blinded fashion by registered EEG technologists or neurologists at MCA, and various aspects of technical quality were rated using 9 statements with a Likert scale (1 = "strongly disagree" to 5 = "strongly agree). Results: Prior to our training efforts, many EEGs obtained at the remote site were deemed "non-interpretable". Qualitative evaluation was undertaken only for EEGs that were interpretable. Out of a possible total score of 45 (9 quality statements, with 5 points being the most positive score), the "pre-training" EEGs were scored at an average of 32.5 (n=6) and the "post-training" EEGs at an average of 33.8 (n=6), a non-significant increase. Some individual technical aspects showed improvement, such as "Impedances were documented at less than 5kOhm" and "Artifacts were identified and minimized", but also not to a statistically significant degree in this limited sample. Conclusions: EEGs obtained in rural hospitals in Arizona may be read by experts at a distance, but only if recordings are made that meet minimal technical requirements. This project is a step in the direction of improving the quality of EEGs by providing education to non-specialist technicians in these areas. This is an ongoing effort that will be modified as more data are collected in order to improve neurologic care in rural Arizona communities.