Use and abuse of stat EEG.

" Clinical judgment is always necessary, and … is superior to any test or technological advance. " Stat testing is unquestionably inherent to medicine, and the issue of stat EEG is a thorny one for every EEG laboratory. Most EEG laboratories acknowledge this as a problem, but there is no consensus on how to address it. How to deal with it is typically the responsibility of the laboratory director, who tries to reconcile the duty and obligation to provide a necessary service on the one hand, and the necessity of avoiding abuse that would make the laboratory unable to function on the other hand. Recognizing the problem , most centers have developed some sort of guidelines to avoid abuse. The issue of stat testing and turnaround time (TAT) is frequently discussed in the laboratory medicine literature [1–9], but there is no such information on EEG. There is certainly abundant literature that discusses indications and usefulness of EEG in various clinical settings, but there is little literature, much less any guidelines , that helps delineate appropriate uses of stat EEGs [10–14]. Many facilities, including most Veterans Hospitals, do not have stat EEGs available. Referral ter-tiary centers should (and do) offer EEGs 24 h/day and stat, but this can only work with certain rules and limitations. Generally, approximately 10% of EEGs are ordered stat [11,14]. A review at our 900-bed tertiary referral hospital indicates that approximately 6% of EEGs are ordered stat. With some 1900 in-patient EEGs performed annually, this translates to over 100 stat EEG requests per year. The vast majority of requests for stat EEGs are for convenience rather than a medical indication. Of the ones with an alleged legitimate medical indication, further scrutiny reveals that about half are not reasonable, need not be performed stat, and can be downgraded to as soon as possible (ASAP) or even routine. Definition of stat Whether it is for a test, procedure or a consultation, 'stat' (from the latin word 'statim', meaning immediately) typically means that it is a medical emergency (i.e., the result is of critical importance, and will affect immediate management and eventual outcome). Stat is the highest degree of medical priority, and in order to be executed , the staff or physician involved should and must interrupt what he/she is doing in order to perform the procedure immediately. Thus, stat procedures are of such medical importance that they should be …