Improving Consistency and Accuracy of Neonatal Amplitude-Integrated Electroencephalography

Abstract

Objective This study aimed to improve the utilization of amplitude-integrated electroencephalography (aEEG) in a neonatal unit by improving aEEG documentation, aEEG knowledge, and pattern recognition ability of neonatal staff.

Methods A quality improvement (QI) program comprising the two Plan-Do-Study-Act (PDSA) cycles was conducted in a level-3 neonatal intensive care unit. The first cycle was focused on improving aEEG documentation with the primary outcome indicator being compliance with aEEG documentation. The second cycle was focused on aEEG interpretation in a health care professional education program with the outcome indicators being accuracy of seizure identification on aEEG and change in conventional EEGs (cEEG) performed. Other outcome indicators included accuracy in identification of background pattern, sleep–wake cycles and artifacts. Process indicators included improvement in aEEG-related knowledge.

Results First PDSA cycle includes lectures on aEEG interpretation, a bedside key, and documentation form. Second PDSA cycle includes online aEEG education pack and detailed aEEG guideline. There was a significant improvement in aEEG documentation after the implementation of both PDSA cycles. Seven of the 46 patients (15.2%) had isolated electrographic seizures which would not have been identified in the pre-aEEG monitoring era. There was an increase in the number of patients with cEEGs done but a steady decrease in number of cEEGs per patient.

Conclusion With the successful application of standardized QI methods, improvements in outcome indicators, such as correct aEEG pattern recognition and improved coverage of at risk infants with cEEGs, were observed. Our QI measures were associated with improvement in aEEG pattern recognition.

Key Points

• Consistent and accurate use of aEEG is challenging.

• Standardized forms and guidelines improve aEEG interpretation consistency and documentation.

• Interactive self-paced online education packs can improve aEEG knowledge and pattern recognition.

Keywords

amplitude-integrated electroencephalography - neonate - quality improvement

Conclusion

We present the findings of a quality improvement project that improves consistency and accuracy of amplitude-integrated electroencephalogram use in a neonatal setting.

Ethical Approval

The quality improvement project was conducted with approval of The Chinese University of Hong Kong, New Territories East Cluster Clinical Research Ethics Committee (reference: 2020.322). As anonymized data were extracted for analysis retrospectively, consent from patients were waived by the Ethics Committee.

Authors' Contributions

K.T. prepared the first draft of the manuscript and made substantial contributions to the management of the patient and literature review. She drafted and revised the manuscript, and gave approval to the final version to be published. She is accountable for all aspects of the work and ensures that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. K.K.M.Y. made substantial contributions to the conception of the report and provided critical intellectual input to the report. In particular, she critically revised the manuscript, and gave approval to the final version to be published. She agreed to be accountable for all aspects of the work and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. H.S.L. made substantial contributions to the conception of the report and interpretation of the data collected. He critically revised the manuscript and gave approval to the final version to be published. He is accountable for all aspects of the work and ensures that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. H.M.C., T.P.Y.M., K.W.S., and E.L.W.F. gave approval to the final version to be published and are accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publication History

Received: 01 July 2021

Accepted: 19 October 2021

Accepted Manuscript online:
25 October 2021

Article published online:
07 December 2021

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