Table 1.

Potential Sources of Management Variability and Delay.

Staffing and Personnel: Attending physicians in critical care and neurology are only periodically on-service. Fellow physicians in critical care and neurology at varying training levels. Rotating fellows from other institutions in critical care and neurology with limited experience at our institution. Rotating pediatrics residents with limited experience in the intensive care unit. Nurse practitioners on a dedicated ICU nurse practitioner service. High volume and intensity of work for all providers with numerous often temporally overlapping patient care responsibilities. Transitions between day and night covering staff. Nurses with limited continuous EEG monitoring experience. EEG technologists with varying levels of experience. EEG technologists with uncertain role expectations regarding EEG screening.

Structural: Communication strategy involving multi-step paging and telephone communication. Multiple clinicians responsible for a given patient (pediatrics resident, critical care medicine fellow, critical care medicine attending, neurology resident, neurology attending, EEG technologist, EEG fellow, EEG attending). Availability of anti-seizure medications for administration in the ICU.

Knowledge Based: Impossible for clinicians to independently read and evaluate all of the available literature given rapid expansion of medical knowledge. Uncertainty regarding standard results communication strategy. Uncertainty regarding standard electrographic seizure management strategy. Uncertainty regarding goals for intervention timing.