Patient-centered care model in IONM: a review and commentary

Area of Science:

• Neuroscience
• Medical Ethics
• Health Informatics

Background:

• Current intraoperative neurophysiological monitoring (IONM) models rely on waveform telemetry, often lacking direct patient interaction or established co-practitioner collegiality.
• Existing remote and nearby care models for IONM do not mandate preoperative patient contact or assume consistent professional relationships.

Purpose of the Study:

• To advocate for a patient-centered care model in IONM, emphasizing routine patient-physician relationships.
• To argue for enhanced collegial relationships between IONM professionals and co-practitioners (proceduralist, anesthesiologist).
• To demonstrate how this professional upgrade improves bioethical positioning and clinical decision-making.

Main Methods:

• Review and commentary on existing IONM practices.
• Argumentation for a normative relationship between the IONM professional (IONM-P) and patients.
• Proposal for sustained collegial relationships among IONM-P, proceduralists, and anesthesiologists.
• Discussion of telemedicine-mediated videoconferencing for current IONM models.

Main Results:

• The proposed patient-centered care model strengthens the IONM-P's bioethical standing.
• Improved co-practitioner relationships enhance the likelihood of correct, context-driven decisions during complex monitoring.
• Current IONM practices can integrate this model using readily available telemedicine technology.

Conclusions:

• Implementing a patient-centered care model with routine patient contact and strong co-practitioner relationships is beneficial for IONM.
• This approach enhances ethical considerations and improves clinical outcomes in neurophysiological monitoring.
• Telemedicine facilitates the adoption of this improved IONM professional practice model.