Renata Glowka, R EEG T. R PSG T Michael JM Raffin, Ph.D. Jagruti Patel, CNIM, R EEG T Micheal Macken, MD Gregory Gruener

1. Neuro-Intra-Operative Monitoring (IOM): Meeting increasing institutional needs, while maintaining quality.(& the “Unexpected” benefits of service development) Renata Glowka, R EEG T. R PSG T Michael JM Raffin, Ph.D. Jagruti Patel, CNIM, R EEG T Micheal Macken, MD Gregory Gruener, MD, MBA

2. Compelling Factors for an “Intervention” • Increasing caseload demands and case complexity • Increasing duration of IOM time/case • Limitations in technologist availability & capabilities • Limitations in technical support • Lack of an integrated intradepartmental strategy • Need for new protocol (& physician) development • New surgical and program monitoring needs

3. Description of Our Project & Aims • Reduce 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 technologists and monitoring of needs/procedures to allow their proper assignment • Meet increased technological needs through strategic equipment purchasing, infrastructure support and wireless intraoperative monitoring transmission to allow “real-time” physician availability for monitoring • Develop new IOM protocols and procedures through faculty and technologist development • Increase institutional satisfaction with IOM services as their needs are met

4. Reliance on Outside Agencies • Solutions that were successfully implemented • Inter-disciplinary involvement in the provision of services • Technologist recruitment and development • Expansion of technologies and personnel skill mix • Maintain compliance with professional standards of care • Successfully integrate new technologies and capabilities • Development of new services • Transcranial cortical motor evoked potentials • Corticography • Functional cortical mapping • Intra-cranial epilepsy monitoring

5. Our results - “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.

6. Our results - Integration of Audiologists Left to right: Kathleen E. Schore, MS, CCC-A, F-AAA; Ying Sun, MS, CCC-A, F-AAA.

7. Our Results - Agency Reduction • Agency reliance: • Reduced from 5% to 0.5% of cases. • Costs: • Agency: $1,720/case, LUHS: $360/case • Per-case cost reduction = 79% • FY2006 cost savings = $30,000

8. IOM service needs - #1: Increasing IOM cases

9. IOM service needs - #2: Increasing monitoring hours

10. IOM service needs - #3: Caseload variability

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

12. Our Results - Our “Customers”….

13. ... and their Satisfaction….

14. …as well as the comments we received from our Surgeons Direct 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.

15. “Unexpected” benefits of IOM service development • Development of a reliable IOM team that has successfully integrated with the surgical teams and surgeons • Increased attractiveness of LUHS to support new surgical faculty who are dependent upon IOM • Increased attractiveness of LUHS to aid future technical staff recruitment and retention • Increasing ability to accommodate emergency surgical cases as well as complicated and extended surgeries • Ability to explore and initiate new synergies with other departments (Audiology/Otolaryngology) as well as support new program development or capability (CV surgery and anesthesiology) • Increased Hospital Administration’s direct involvement and support • Establishing Level 4 Epilepsy Center

16. Opportunities for Continued Development • Continued daily monitoring of OR schedule to ensure timely response to the present demands for services. • Design and implementation of studies for post-surgical outcomes. • Support for basic and applied research opportunities. • Expansion of available resources to meet increasing as well as new demands.