Overview - Hospitals and Health Care Facilities

CONSULTING INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING - THE STANDARD OF CARE FOR NEUROSURGICAL AND ORTHOPEDIC PATIENTS.

Even in the most experienced hands, surgery on or near the brain, spinal cord or nerves has the potential for adverse outcome. This risk increases with procedure complexity and/or patient-related factors.

Consulting intraoperative neurophysiological monitoring (IONM) significantly reduces adverse outcomes and iatrogenic physical impairment. Without it, injury is noted only in the recovery room, rather than during the procedure itself; often, it is then too late to reverse.

For more than 25 years, IONM has been available in specialized academic settings. Now, through significant IT developments, it is accessible to all hospitals using remote monitoring, thereby helping an increasing number of patients.

Specialist professional expertise is mandatory since: a) monitoring methods are constantly changing due to IT and bandwidth improvements providing the capability to transmit very complex data and b) the increasingly sophisticated array of neurophysiological testing available allows more precise monitoring.

Consulting IONM enhances the quality of the interaction between the surgical and neuromonitoring teams and is accepted as the standard of care for the management of patients during neurosurgical and orthopedic procedures.

By avoiding/ reducing the incidence of intraoperative complications, length of stay can be shortened when IONM is used.

Malpractice premiums may be reduced with IONM and insurers have designated hospitals as specialist centers, increasing the reimbursement level based on IONM use.

SENTIENT- ASSURANCE OF QUALITY

Consulting IONM requires exemplary specialist skills. These are assured by:

• Exceptionally trained and neurologically experienced personnel,
• Vigilant continuous real-time mentoring of technical staff
• Closed loop feedback of an aggressive Quality Assurance  program.

At Sentient, over 50% of our surgical neurophysiologists have masters or doctorate level degrees in the biomedical/clinical sciences, all are CNIM certified or eligible, and many have additional clinical experience with EEG, EP, chiropractic, or nursing backgrounds. Providing continuous neurological consultative supervision is our staff of full time neurologists. Together with a third member, the Senior Supervisory Specialist (SISS) - an exceptionally experienced, medically qualified neurophysiologist who also oversees the case from a technical standpoint - these form the Neuromonitoring Team that partners with the surgeon and anesthesiologist to provide protection for the patient's nervous system.

A multi-tiered Quality Assurance program is in place:

• Immediate term: with the direct supervision of technical staff by the SISS and the Consulting Neurologist;
• Intermediate term:  each monitoring dataset is in addition to contemporaneous consultation, reviewed retrospectively and QA data generated by the consulting neurologist formulating feedback to the surgical neurophysiologist where and when necessary.
• QA data are entered into a database reviewed monthly at a QA meeting and higher level (practice wide) or mid level (regional) or low level (individual) follow up provided and documented-Long term QA control.

Hospitals are provided at their request with Quarterly QA reports detailing Alerts, Adverse outcomes and QA data for the technicians and the neurologists providing specialist services to their institution.

Consulting Neurologists have completed specialty neurological training in recognized US programs, (in most cases a subspecialty neurophysiology Fellowship with significant IONM training), have on average monitored several thousand IONM cases, and are committed full-time to IONM, QA for the neurologists is completed on a quarterly basis and information provided to requesting hospitals.

This rigorous QA program assures compliance with institutional credentialing standards and compliance with Joint Commission requirements.

CONSULTING NEUROPHYSIOLOGICAL SURGICAL MONITORING IS A REMOTE TELEMEDICINE SPECIALTY

The majority of intraoperative medical supervision is performed by remote linkage. The paradigm used by Sentient is for a surgical neurophysiologist to be present in the OR with the surgical team and patient, concentrating only on that procedure, in constant communication via a secure, stable, HIPAA compliant teleconferencing visual link with a consulting neurologist directing the monitoring team remotely in real time.

Continuous interaction occurs among the Neuromonitoring Team members (surgical neurophysiologist, consulting neurologist and SISS) and the Surgical Team. Neurophysiological signal acquisition lends itself most readily to this approach. This allows the leveraging of exceptional expertise so that patients will be assured of the most advanced and competent monitoring.

Expertise is hard to come by, especially in rural and remote communities so telemedicine affords the opportunity to provide exemplary coverage which otherwise would not be available.

WHY SENTIENT?

A leading provider of IONM services since 1995, Sentient numbers among its staff, internationally- recognized authorities and pioneers in the field. The collective practice experience comprises nearly a quarter of a million orthopedic, neurosurgical and vascular cases, with each neurologist having supervised several thousand cases and each surgical neurophysiologist at least 100 cases before being allowed to monitor independently.

Education and training are directed by Dr Chuck Yingling, a past president and founding member of the American Society of Neurophysiological Monitoring who pioneered many of the techniques in use today. Assuring operational excellence is Ms Sabrina Galloway a past President of the American Society of Electroneurodiagnostic Technologists who started as one of the very first IONM technicians, and has first hand experience of running complex IONM operations over many years. Together with the QA program, the experience and subspecialty training of our consulting neurologists and surgical neurophysiologists, this assures unparalleled monitoring quality for patients.

SENTIENT - A CLINICAL PARTNER

From large, multi -thousand bed tertiary academic centers performing highly specialized, complex spine and brain surgical procedures, to smaller rural facilities, Sentient prides itself on the range of interventions on which we are consulted and the hospitals with which we partner. Sentient is a national leader in consultative monitoring with the ability to provide expertise in all states and internationally.

Staying at the forefront of the specialty is a pre-requisite for Sentient. Our research partnerships with several premier Universities ensure that we are always aware of the latest developments, and are taking an active role in spearheading new methods for monitoring surgical patients.

Sentient academic neurologists and senior neurophysiologists actively publish annually in high impact peer reviewed journals. For two consecutive years, Sentient has been awarded the research prize of the ASNM. Sentient academic staff are reviewers for over 30 peer-review professional journals in clinical medicine, and basic sciences, and our staff serve on the editorial boards of several international neurological/neurophysiological journals and societies.

DATA REPORTING

Data for each case are recorded and stored in accordance with HIPAA requirements and reports are issued within a short period of case completion. These are available for the medical record, and the surgeon’s office and offer an overview and interpretation of the neurophysiological aspects of the case.