Neuro-Intra-Operative Monitoring (IOM): Neuro-Intra-Operative Monitoring (IOM): Meeting increasing institutional needs, Meeting increasing institutional needs,

while maintaining quality.while maintaining quality.

(& the “Unexpected” benefits of service development)(& the “Unexpected” benefits of service development)

Renata Glowka, R EEG T. R PSG TRenata Glowka, R EEG T. R PSG TMichael JM Raffin, Ph.D.Michael JM Raffin, Ph.D.Jagruti Patel, CNIM, R EEG TJagruti Patel, CNIM, R EEG TMicheal Macken, MDMicheal Macken, MDGregory Gruener, MD, MBAGregory Gruener, MD, MBA

Compelling Factors for an Compelling Factors for an “Intervention”“Intervention”

Increasing caseload demands and case complexityIncreasing caseload demands and case complexity Increasing duration of IOM time/caseIncreasing duration of IOM time/case Limitations in technologist availability & capabilitiesLimitations in technologist availability & capabilities Limitations in technical supportLimitations in technical support Lack of an integrated intradepartmental strategyLack of an integrated intradepartmental strategy Need for new protocol (& physician) developmentNeed for new protocol (& physician) development New surgical and program monitoring needsNew surgical and program monitoring needs

Description of Our Project & AimsDescription of Our Project & Aims Reduce usage of outside agencies by technologist developmentReduce usage of outside agencies by technologist development

Maintain Loyola’s standards of excellence through active monitoring of service and feedback from “customers”

4-step career ladder and cross-training process developed for technologists as well as their professional support to encourage certification

Collaboration with the Department of Audiology to develop new skills of their Audiologists that allow their use in some IOM roles

Meet increased volume and availability demands by cross-training of Meet increased volume and availability demands by cross-training of technologists and monitoring of needs/procedures to allow their technologists and monitoring of needs/procedures to allow their proper assignmentproper assignment

Meet increased technological needs through strategic equipment Meet increased technological needs through strategic equipment purchasing, infrastructure support and wireless intraoperative purchasing, infrastructure support and wireless intraoperative monitoring transmission to allow “real-time” physician availability monitoring transmission to allow “real-time” physician availability for monitoringfor monitoring

Develop new IOM protocols and procedures through faculty and Develop new IOM protocols and procedures through faculty and technologist developmenttechnologist development

Increase institutional satisfaction with IOM services as their needs Increase institutional satisfaction with IOM services as their needs are metare met

Reliance on Outside AgenciesReliance on Outside Agencies Solutions that were successfully implementedSolutions that were successfully implemented

Inter-disciplinary involvement in the provision of Inter-disciplinary involvement in the provision of servicesservices

Technologist recruitment and developmentTechnologist recruitment and development Expansion of technologies and personnel skill mixExpansion of technologies and personnel skill mix

• Maintain compliance with professional standards of careMaintain compliance with professional standards of care• Successfully integrate new technologies and capabilitiesSuccessfully integrate new technologies and capabilities

Development of new servicesDevelopment of new services• Transcranial cortical motor evoked potentialsTranscranial cortical motor evoked potentials• CorticographyCorticography• Functional cortical mappingFunctional cortical mapping• Intra-cranial epilepsy monitoringIntra-cranial epilepsy monitoring

Our results - Our results - “New” Intra-Operative Monitoring Technologists“New” Intra-Operative Monitoring Technologists

Left to right: Denise Rys, Jagruti Patel, R. EEG T., CNIM,Gazenfer Sherazeen, R. EEG T., CNIM, Renato Cunanan, R. EEG T.

Our results - Our results - Integration of AudiologistsIntegration of Audiologists

Left to right: Kathleen E. Schore, MS, CCC-A, F-AAA;Ying Sun, MS, CCC-A, F-AAA.

Our Results - Agency ReductionOur Results - Agency Reduction

Agency Usage

2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6

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Proje cte d Incre as e s

QI Pr oje ct Im ple m e ntation

Pre dicte d QIPro je ct im pact

Costs:Costs: Agency: $1,720/case, LUHS: $360/caseAgency: $1,720/case, LUHS: $360/case Per-case cost reduction = 79%Per-case cost reduction = 79% FY2006 cost savings = $30,000FY2006 cost savings = $30,000

Agency reliance:Agency reliance: Reduced from 5% to 0.5% of cases.Reduced from 5% to 0.5% of cases.

IOM service needs - #1: Increasing IOM casesIOM service needs - #1: Increasing IOM casesIOM Referra ls

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IOM service needs - #2: Increasing monitoring hoursIOM service needs - #2: Increasing monitoring hoursIOM Hours by Fiscal Year

M e a n 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5

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1 0 0

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7 0 %

IOM service needs - #3: Caseload variabilityIOM service needs - #3: Caseload variabilityIO M Cas es x w e ekda y x fisca l yea r

Y e a r 2 0 0 4 Y e a r 2 0 0 5 Y e a r 2 0 0 6

S u M o T u We T h Fr S a

Da y

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All of these IOM service needs were met by “matching” them All of these IOM service needs were met by “matching” them to IOM staff availability and cross-coverageto IOM staff availability and cross-coverage

IO M Hours by w eek day x fis ca l yea r

2 0 0 4 2 0 0 5 2 0 0 6

S u M o T u We T h Fr S a

Da y

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4 0 0

5 0 0

6 0 0

7 0 0

8 0 0

9 0 0

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Ho

urs

Our Results - Our “Customers”…. Our Results - Our “Customers”….

2005 IO M Referral Sources

N euro.

Mixed

Thorac.-Vasc.

Ortho.

EN T

... and their Satisfaction….... and their Satisfaction….

…as well as the comments we received from our SurgeonsDirect Quotes

• Staff are very cooperative and helpful• Excellent service. Dr. Macken works well with service. This service is very

accommodating. Good job.• Suggestions for service improvement: None. Excellent staff.• Suggestions for service improvement: None. Audiology provides an excellent service to

our Dept.• The biggest problem we still face is the occasional background artifact rendering effective

monitoring useless. Monitoring team and bioengineering employees still have no answers. Must solve this issue!

• Great service. Looking forward to doing collaborative research.• Nice team.• Technicians are very good and interact well with both the anesthesia teams and surgeons.

Good at timely setup with minimal delays. It may be worthwhile to expand the service by one more individual since I do see locums neurophysiology techs here on occasion.

• I believe your services are all very good.

““Unexpected” benefits of IOM service developmentUnexpected” benefits of IOM service development

Development of a reliable IOM team that has successfully integrated Development of a reliable IOM team that has successfully integrated with the surgical teams and surgeonswith the surgical teams and surgeons

Increased attractiveness of LUHS to support new surgical faculty who Increased attractiveness of LUHS to support new surgical faculty who are dependent upon IOMare dependent upon IOM

Increased attractiveness of LUHS to aid future technical staff Increased attractiveness of LUHS to aid future technical staff recruitment and retentionrecruitment and retention

Increasing ability to accommodate emergency surgical cases as well Increasing ability to accommodate emergency surgical cases as well as complicated and extended surgeriesas complicated and extended surgeries

Ability to explore and initiate new synergies with other departments Ability to explore and initiate new synergies with other departments (Audiology/Otolaryngology) as well as support new program (Audiology/Otolaryngology) as well as support new program development or capability (CV surgery and anesthesiology)development or capability (CV surgery and anesthesiology)

Increased Hospital Administration’s direct involvement and supportIncreased Hospital Administration’s direct involvement and support Establishing Level 4 Epilepsy CenterEstablishing Level 4 Epilepsy Center

Opportunities for Continued Opportunities for Continued DevelopmentDevelopment

Continued daily monitoring of OR schedule to Continued daily monitoring of OR schedule to ensure timely response to the present demands ensure timely response to the present demands for services.for services.

Design and implementation of studies for post-Design and implementation of studies for post-surgical outcomes.surgical outcomes.

Support for basic and applied research Support for basic and applied research opportunities.opportunities.

Expansion of available resources to meet Expansion of available resources to meet increasing as well as new demands.increasing as well as new demands.