In-House Intraoperative Monitoring in Neurosurgery in England - Benefits and Challenges

Area of Science:

• Neurosurgery
• Healthcare Management
• Medical Monitoring

Background:

• Intraoperative neurophysiological monitoring (IOM) enhances neurosurgical outcomes in cranial and spinal procedures.
• NHS hospitals may outsource IOM to private companies, incurring significant costs.
• Developing in-house IOM services presents both benefits and challenges for NHS trusts.

Purpose of the Study:

• To assess the expenditure on outsourced IOM in NHS neurosurgical departments in England.
• To compare the costs of outsourced IOM with standard NHS staff salaries.
• To evaluate the feasibility and advantages of establishing in-house IOM services.

Main Methods:

• A survey of NHS neurosurgical departments across England from January 2018 to December 2022.
• Analysis of Freedom of Information requests regarding IOM expenditure for cranial and spinal surgery.
• Compilation of standard NHS England salaries for relevant neurophysiology staff.

Main Results:

• Total expenditure on outsourced IOM exceeded £8 million over four years.
• Annual spending on outsourced IOM increased from £1.1 million in 2018 to £3.5 million in 2022.
• The highest single unit yearly spend on outsourced IOM reached £568,462.

Conclusions:

• IOM is vital for surgical decision-making, reducing complications and hospital stays.
• High demand for IOM exceeds NHS internal provision, necessitating costly outsourcing.
• In-house IOM services offer benefits including cost reduction, workforce training, and improved consistency.