Advertisement

Is the new ASNM intraoperative neuromonitoring supervision “guideline” a trustworthy guideline? A commentary

  • Stanley A. SkinnerEmail author
  • Elif Ilgaz Aydinlar
  • Lawrence F. Borges
  • Bob S. Carter
  • Bradford L. Currier
  • Vedran Deletis
  • Charles Dong
  • John Paul Dormans
  • Gea Drost
  • Isabel Fernandez-Conejero
  • E. Matthew Hoffman
  • Robert N. Holdefer
  • Paulo Andre Teixeira Kimaid
  • Antoun Koht
  • Karl F. Kothbauer
  • David B. MacDonald
  • John J. McAuliffeIII
  • David E. Morledge
  • Susan H. Morris
  • Jonathan Norton
  • Klaus Novak
  • Kyung Seok Park
  • Joseph H. Perra
  • Julian Prell
  • David M. Rippe
  • Francesco Sala
  • Daniel M. Schwartz
  • Martín J. Segura
  • Kathleen Seidel
  • Christoph Seubert
  • Mirela V. Simon
  • Francisco Soto
  • Jeffrey A. Strommen
  • Andrea Szelenyi
  • Armando Tello
  • Sedat Ulkatan
  • Javier Urriza
  • Marshall Wilkinson
Commentary
  • 28 Downloads

Introduction: provider-centered versus patient-centered IONM supervision

The new ASNM intraoperative neuromonitoring (IONM) supervision guideline [1] attempts to justify current remote IONM practices.1 Contrary to ordinary clinical practice guideline development, it is provider-centered, not patient-centered.

The new guideline could have embraced recent scholarship that indicates the need to provide robust teamwork and medical error avoidance. It could have moved in the direction of improved patient safety and outcomes. Instead, key words are repeated (“communicate,” “collaborate,” “team”) many times, but with no meaningful strategy to achieve their patient safety potential. In fact, within this new guideline, an IONM remote provider’s communication with in-room physician peers and co-practitioners is defined as: “… at minimum, direct voice access (via ‘land-line’ or cellular network) for perioperative communication with the surgical team”.

The evidence for optimized intraoperative...

Notes

Acknowledgements

Stanley A Skinner, M.D.: Director, Intraoperative Neurophysiology Department, Abbott Northwestern Hospital Minneapolis, MN, USA; Endorsed by: Peter Newton, M.D.: Scoliosis Research Society (SRS) President, Paul Sponseller, M.D.: SRS President elect Muharrem Yazici, M.D.: SRS Vice President Todd Albert, M.D.: SRS Past President, On behalf of the SRS; Elif Ilgaz Aydinlar, M.D.: Treasurer, International Society of Intraoperative Neurophysiology, Acibadem University School of Medicine, Department of Neurology, Istanbul, Turkey; Lawrence F. Borges, M.D.: Associate Professor of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Bob S. Carter, M.D., Ph.D.: William and Elizabeth Sweet Professor of Neurosurgery, Harvard Medical School, Head of the Department of Neurosurgery, Massachusetts General Hospital, Boston, MA; Bradford L. Currier, M.D.: Professor of Orthopedics and Neurosurgery, Consultant, Department of Orthopedics, Director, Spine Surgery Fellowship, Mayo Clinic, Rochester, MN, USA; Vedran Deletis, M.D., Ph.D.: Past President International Society of Intraoperative Neurophysiology, Albert Einstein College of Medicine, New York, NY, USA; Charles Dong, Ph.D.: Founding member Canadian Association of Neurophysiological Monitoring, Clinical Associate Professor, Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; John Paul Dormans, M.D.: Chief, Pediatric Orthopedic Surgery, Riley Hospital for Children, Garceau Professor of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Gea Drost, M.D., Ph.D.: Secretary International Society of Intraoperative Neurophysiology, Department of Neurosurgery/Neurology, University Medical Center Groningen, Groningen, The Netherlands; Isabel Fernandez-Conejero, M.D.: President elect International Society of Intraoperative Neurophysiology, Department of Intraoperative Neurophysiology, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain; E. Matthew Hoffman, D.O., Ph.D.: Assistant Professor, Department of Neurology, Mayo Clinic, Rochester, MN, USA; Robert N. Holdefer, Ph.D.: Associate Professor, Department of Rehabilitation Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA; Paulo Andre Teixeira Kimaid, M.D., Ph.D.: President Latin American Chapter International Federation Clinical Neurophysiology, Past President Brazilian Society of Clinical Neurophysiology, Chairman, Intraoperative Neuromonitoring Section, Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil; Antoun Koht, M.D.: Past President American Society Neurophysiological Monitoring, Professor of Anesthesiology, Neurological surgery and Neurology, Chief, neurosurgical anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Karl F. Kothbauer, M.D.: Chief, Division of Neurosurgery, Luzerner Kantonsspital, Associate Professor, University of Basel, CH-6000 Luzern, Switzerland; David B. MacDonald, M.D., FRCP(C), ABCN: Department of Neurosciences, Section of Neurophysiology, King Faisal Specialist Hospital & Research center, MBC 76, PO Box 3354, Riyadh, 11211, Saudi Arabia; John J. McAuliffe III, M.D., MBA: Past President American Society Neurophysiological Monitoring, Professor and Anesthesiologist-in-Chief, Department of Anesthesia, Cincinnati Children’s Hospital, The University of Cincinnati, Cincinnati, Ohio, USA; David E Morledge, Ph.D., CCC-A, DABNM, FASNM, Past President American Society Neurophysiological Monitoring, Neurostatus Eagle, ID USA’Susan H. Morris, Ph.D.: Past President Canadian Association of Neurophysiological Monitoring, IWK Children’s Health Program & Division of Neurosurgery, Dalhousie University Halifax, NS Canada; Jonathan Norton, Ph.D.: Founding member and Past President Canadian Association Neurophysiological Monitoring, Assistant Professor and Clinical Neurophysiologist, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Klaus Novak, M.D.: Dept. of Neurosurgery, Medical University of Vienna, Vienna, Austria; Kyung Seok Park, M.D., Ph.D.: Delegate by Liaison, International Society of Intraoperative Neurophysiology, Professor, Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Joseph H Perra, M.D.: Twin Cities Spine Center, Minneapolis, MN USA; Julian Prell, M.D., P.D.: Credentialing Committee (Co-Chair) International Society Intraoperative Neurophysiology, Martin Luther University of Halle-Wittenberg, Department of Neurosurgery, Halle (Saale), Germany; David M Rippe, M.D.: Neurophysiology Department, Abbott Northwestern Hospital Minneapolis, MN, USA; Francesco Sala, M.D.: Professor and Chairman, Section of Neurosurgery, Dept. of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy; Daniel M Schwartz, Ph.D.: Founding Member American Society Neurophysiological Monitoring, Founder Surgical Monitoring Associates Springfield, PA USA; Martín J. Segura, M.D., Ph.D.: Past President Argentine Society of EEG and Clinical Neurophysiology, Founding member Special Interest Group Neurophysiological Intraoperative Monitoring, Latin-American, Chapter International Federation of Clinical Neurophysiology, Assistant Professor University of Buenos Aires Medical School, Head Clinical Neurophysiology Unit, Hospital Garrahan, Buenos Aires, Argentina; Kathleen Seidel, M.D.: Attending Physician, Intraoperative Neurophysiology and Neuro-oncological Surgery, Department of Neurosurgery, Inselspital Bern University Hospital, Bern, Switzerland; Christoph Seubert, M.D., Ph.D.: Professor of Anesthesiology and Neurosurgery, Chief, Division of Neuroanesthesia University of Florida, College of Medicine, Gainesville, Florida USA; Mirela V. Simon, M.D., M.Sc.: Associate Professor of Neurology, Harvard Medical School, Director, Intraoperative Neurophysiology Unit, Program Director, IONM Fellowship, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Francisco Soto, M.D.: President International Society of Intraoperative Neurophysiology, Neurology Department, Clínica Las Condes, Santiago de Chile; Jeffrey A. Strommen, M.D.: Assistant professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Neurophysiology Department, Abbott Northwestern Hospital, Minneapolis, MN, USA; Andrea Szelenyi, M.D., P.D.: Prof. Dr. Andrea Szelenyi, Past President International Society of Intraoperative Neurophysiology, Clinical and Intraoperative Neurophysiology, Department of Neurosurgery, Hospital of University of Munich, Ludwig Maximilians Universitaet Muenchen (LMU), Munich, Germany; Armando Tello, M.D., Ph.D.: Past President Mexican Society of Clinical Neurophysiology, Founding Member IONM Special Interest Group: Latin American Chapter International Federation, Clinical Neurophysiology, Head, Clinical Neurophysiology Department, Hospital Español, Mexico City, Mexico; Sedat Ulkatan, M.D., DABNM, CNIM: Director of Intraoperative Monitoring Service, Mount Sinai West Hospital-New York NY. USA; Javier Urriza, M.D.: Educational Committee Co-Chair International Society of Intraoperative Neurophysiology, Intraoperative Neurophysiology Unit, Clinical Neurophysiology Deptartment, Complejo Hospitalario de Navarra—B, Pamplona-Iruña, Navarra, Spain; Marshall Wilkinson, B.Sc. (Hons), M.Sc., Ph.D.: Current President Canadian Association Neurophysiological Monitoring, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.

Funding

No author received funding for the authorship of this commentary.

Compliance with ethical standards

Conflict of interest

Dr. Skinner receives a patent royalty from Medtronic, Inc. No pertinent conflicts of interest are reported.

References

  1. 1.
    Gertsch JH, Moreira JJ, Lee GR, et al. J Clin Monit Comput. 2018.  https://doi.org/10.1007/s10877-018-0201-9.Google Scholar
  2. 2.
    Kohn LT, Corrigan J, Donaldson MS. To err is Human: building a safer health system. Washington, DC: National Academies Press; 2000.Google Scholar
  3. 3.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian health care study. Med J Aust. 1995;163:458–71.Google Scholar
  4. 4.
    Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13:185–90.CrossRefGoogle Scholar
  5. 5.
    Lingard L, Reznick R, Espin S, et al. Team communications in the operating room: talk patterns, sites of tension, and implications for novices. Acad Med. 2002;77:232–7.CrossRefGoogle Scholar
  6. 6.
    Lingard L, Espin E, Whyte S, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care. 2004;13:330–4.CrossRefGoogle Scholar
  7. 7.
    ElBardissi AW, Sundt TM. Human factors and operating room safety. Surg Clin North Am. 2012;92:21–35.CrossRefGoogle Scholar
  8. 8.
    Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM III. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 2007;142:658–65.CrossRefGoogle Scholar
  9. 9.
    Croskerry P. From mindless to mindful practice—cognitive bias and clinical decision making. N Engl J Med. 2013;368(26):2445–8.CrossRefGoogle Scholar
  10. 10.
    Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5):S2–S23.CrossRefGoogle Scholar
  11. 11.
    Sala F. Intraoperative neurophysiology is here to stay. Child’s Nerv Syst. 2010;26(4):413–7.CrossRefGoogle Scholar
  12. 12.
    Sacks GD, Shannon EM, Dawes AJ, et al. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. BMJ Qual Saf. 2015;24:458–67.CrossRefGoogle Scholar
  13. 13.
    Skinner S, Holdefer R, McAuliffe JJ, Sala F. Medical error avoidance in intraoperative neurophysiological monitoring: the communication imperative. J Clin Neurophysiol. 2017;34(6):477–83.CrossRefGoogle Scholar
  14. 14.
    World Health Organization. In: Gawande A, Weiser T, editors. WHO Guidelines for Safe Surgery 2009: safe surgery saves lives. Geneva: WHO Press; 2009.Google Scholar
  15. 15.
    Skinner S. Patient-centered care model in IONM. J Clin Neurophysiol. 2013;30:204–9.CrossRefGoogle Scholar
  16. 16.
    Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, Thomas RG, Lyden PD. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol. 2008;7(9):787–95.CrossRefGoogle Scholar
  17. 17.
    Handschu R, Scibor M, Willaczek B, Nückel M, Heckmann JG, Asshoff D, Belohlavek D, Erbguth F, Schwab S. Telemedicine in acute stroke. J Neurol. 2008;255(11):1792–7.CrossRefGoogle Scholar
  18. 18.
    Lilly CM, McLaughlin JM, Zhao H, Baker SP, Cody S, Irwin RS. A multicenter study of ICU telemedicine reengineering of adult critical care. Chest. 2014;145(3):500–7.CrossRefGoogle Scholar
  19. 19.
    Dormans JP. Establishing a standard of care for neuromonitoring during spinal deformity surgery. Spine. 2010;35(25):2180–5.CrossRefGoogle Scholar
  20. 20.
    U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare and Medicaid programs: changes affecting hospital and critical access hospital conditions of participation: telemedicine credentialing and privileging (RIN 0938-AQ05). 2011. Available at: http://www.gpo.gov/fdsys/pkg/FR-2011-05-05//html/FR-2011-05-05-FrontMatter.htm. Accessed 8 Feb 2012.
  21. 21.
    Skinner SA, Cohen BA, Morledge DE, McAuliffe JJ, Hastings JD, Yingling CD, McCaffrey M. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. J Clin Monit Comput. 2014;28(2):103–11.CrossRefGoogle Scholar
  22. 22.
    Steinberg E, Greenfield S, Wolman DM, Mancher M, Graham R, editors. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.Google Scholar
  23. 23.
    Shekelle P, Eccles MP, Grimshaw JM, Woolf SH. When should clinical guidelines be updated? BMJ 2001;323(7305):155.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Stanley A. Skinner
    • 1
    Email author
  • Elif Ilgaz Aydinlar
    • 2
  • Lawrence F. Borges
    • 3
  • Bob S. Carter
    • 4
  • Bradford L. Currier
    • 5
  • Vedran Deletis
    • 6
  • Charles Dong
    • 7
  • John Paul Dormans
    • 8
  • Gea Drost
    • 9
  • Isabel Fernandez-Conejero
    • 10
  • E. Matthew Hoffman
    • 11
  • Robert N. Holdefer
    • 12
  • Paulo Andre Teixeira Kimaid
    • 13
  • Antoun Koht
    • 14
  • Karl F. Kothbauer
    • 15
  • David B. MacDonald
    • 16
  • John J. McAuliffeIII
    • 17
  • David E. Morledge
    • 18
  • Susan H. Morris
    • 19
  • Jonathan Norton
    • 20
  • Klaus Novak
    • 21
  • Kyung Seok Park
    • 22
  • Joseph H. Perra
    • 23
  • Julian Prell
    • 24
  • David M. Rippe
    • 25
  • Francesco Sala
    • 26
  • Daniel M. Schwartz
    • 27
  • Martín J. Segura
    • 28
  • Kathleen Seidel
    • 29
  • Christoph Seubert
    • 30
  • Mirela V. Simon
    • 31
  • Francisco Soto
    • 32
  • Jeffrey A. Strommen
    • 33
    • 34
  • Andrea Szelenyi
    • 35
  • Armando Tello
    • 36
  • Sedat Ulkatan
    • 37
  • Javier Urriza
    • 38
  • Marshall Wilkinson
    • 39
  1. 1.Intraoperative Neurophysiology DepartmentAbbott Northwestern HospitalMinneapolisUSA
  2. 2.Acibadem University School of Medicine, Department of NeurologyIstanbulTurkey
  3. 3.Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  4. 4.Department of NeurosurgeryHarvard Medical School, Massachusetts General HospitalBostonUSA
  5. 5.Department of OrthopedicsMayo ClinicRochesterUSA
  6. 6.Albert Einstein College of MedicineNew YorkUSA
  7. 7.Division of Neurosurgery, Department of SurgeryUniversity of British ColumbiaVancouverCanada
  8. 8.Pediatric Orthopedic SurgeryRiley Hospital for Children, Indiana University School of MedicineIndianapolisUSA
  9. 9.Department of Neurosurgery/NeurologyUniversity Medical Center GroningenGroningenThe Netherlands
  10. 10.Department of Intraoperative NeurophysiologyHospital Universitari de BellvitgeBarcelonaSpain
  11. 11.Department of NeurologyMayo ClinicRochesterUSA
  12. 12.Department of Rehabilitation MedicineUniversity of Washington, Harborview Medical CenterSeattleUSA
  13. 13.Department of NeurosurgeryFederal University of São PauloSão PauloBrazil
  14. 14.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  15. 15.Division of Neurosurgery, Luzerner KantonsspitalUniversity of BaselLucerneSwitzerland
  16. 16.Department of Neurosciences, Section of NeurophysiologyKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
  17. 17.Department of Anesthesia, Cincinnati Children’s HospitalThe University of CincinnatiCincinnatiUSA
  18. 18.NeurostatusEagleUSA
  19. 19.IWK Children’s Health Program & Division of NeurosurgeryDalhousie UniversityHalifaxCanada
  20. 20.Department of SurgeryUniversity of SaskatchewanSaskatoonCanada
  21. 21.Department of NeurosurgeryMedical University of ViennaViennaAustria
  22. 22.Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
  23. 23.Twin Cities Spine CenterMinneapolisUSA
  24. 24.Department of NeurosurgeryHalle (Saale)Germany
  25. 25.Neurophysiology DepartmentAbbott Northwestern HospitalMinneapolisUSA
  26. 26.Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement SciencesUniversity HospitalVeronaItaly
  27. 27.Surgical Monitoring AssociatesSpringfieldUSA
  28. 28.Clinical Neurophysiology Unit, Hospital GarrahanUniversity of Buenos Aires Medical SchoolBuenos AiresArgentina
  29. 29.Intraoperative Neurophysiology and Neuro-oncological Surgery, Department of NeurosurgeryInselspital Bern University HospitalBernSwitzerland
  30. 30.Division of Neuroanesthesia, College of MedicineUniversity of FloridaGainesvilleUSA
  31. 31.Intraoperative Neurophysiology Unit, Department of NeurologyHarvard Medical School, Massachusetts General HospitalBostonUSA
  32. 32.Neurology DepartmentClínica Las CondesSantiagoChile
  33. 33.Department of Physical Medicine and RehabilitationMayo ClinicRochesterUSA
  34. 34.Neurophysiology DepartmentAbbott Northwestern HospitalMinneapolisUSA
  35. 35.Clinical and Intraoperative Neurophysiology, Department of NeurosurgeryHospital of University of Munich, Ludwig Maximilians Universitaet Muenchen (LMU)MunichGermany
  36. 36.Clinical Neurophysiology DepartmentHospital EspañolMexico CityMexico
  37. 37.Intraoperative Monitoring ServiceMount Sinai West HospitalNew YorkUSA
  38. 38.Intraoperative Neurophysiology Unit, Clinical Neurophysiology DepartmentComplejo Hospitalario de Navarra – B, Pamplona-IruñaNavarraSpain
  39. 39.Section of NeurosurgeryUniversity of ManitobaWinnipegCanada

Personalised recommendations