An audit of electroencephalography requests: use and misuse

Area of Science:

• Clinical Neurology
• Diagnostic Imaging
• Healthcare Auditing

Background:

• Clinical guidelines recommend specific criteria for requesting electroencephalogram (EEG) tests.
• Adherence to these guidelines ensures appropriate utilization of diagnostic resources and timely patient care.

Purpose of the Study:

• To evaluate the appropriateness of electroencephalogram (EEG) requests at St George's Hospital (SGH) against established clinical guidelines.
• To assess the diagnostic yield and waiting times for EEG procedures.

Main Methods:

• A retrospective audit of adult National Health Service (NHS) patients undergoing standard EEG between November 2003 and January 2004.
• Data collection from case notes, request forms, and EEG reports, compared against predetermined criteria for appropriateness and waiting times.

Main Results:

• Twenty-six percent of EEG requests were deemed inappropriate, primarily for "funny turns" lacking sufficient clinical justification.
• EEG contributed to diagnosis or management in only 22% of cases, with all appropriately requested EEGs yielding diagnostic value.
• Waiting times exceeded the 4-week guideline for 42% of patients, with less than 10% of outpatients meeting this target.

Conclusions:

• A significant proportion of EEG referrals do not adhere to clinical guidelines, often stemming from a misunderstanding of EEG's role in diagnosing epilepsy.
• Suboptimal waiting times, especially for outpatients, indicate potential service inefficiencies.
• Strategies are needed to improve the appropriate utilization of EEG services and reduce patient waiting times.