Requests for electroencephalography in a district general hospital: retrospective and prospective audit

Objectives To determine the number of inappropriate requests for electroenc ephalography (EEG) and whether guidelines an use could reduce this number. Design Audit with retrospective and prospective components. Setting EEG department in district general hospital and centre for neurolog y and neurosurgery. Participants Retrospective: 368 at the general hospital and 143 patients at the neurology centre. Prospective: 241 patients undergoing EEG at the gene ral hospital. Interventions Guidelines for EEG issued to users of service at the general hospital. Outcomes Retrospective: differences in requesting practice, result in diffe rent clinical scenarios, relative roles of procedure, clinical acumen in es tablishing diagnosis, usefulness of procedure. Prospective: change of reque sting practice, impact on use. Results There were considerable differences in requesting practice. Non-spe cialists seem to use EEG as a diagnostic tool, especially in patients with "funny turns," when it is much more likely to yield potentially misleading than clinically useful information. The cn el all proportion of procedures considered to influence management, to be justifiable, and to be inappropri ate were 16% (59), 28.3% (104), and 55.7% (205), respectively. In the prosp ective study the total number of requests was significantly reduced (chi (2 ) = 33.85, df = 5, P < 0.0001), mainly because of fewer requests in patient s with non-specific "funny turns" (<chi>(2) = 21.90, df = 6, P = 0.0013). T here was a concomitant change in the usefulness of EEG (chi (2) 26.99, df = 2, P < 0.0001). Conclusions This original audit informed clinical practice and had potentia l benefits for patients, clinicians, and provision of service. Systematic r eplication of this project possibly on a regional basis, could result in fi nancial savings, which would allow development of accessible local neurophy siology services.