Is the new ASNM intraoperative neuromonitoring supervision “guideline” a trustworthy guideline? A commentary
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Introduction: provider-centered versus patient-centered IONM supervision
The new ASNM intraoperative neuromonitoring (IONM) supervision guideline  attempts to justify current remote IONM practices.1 Contrary to ordinary clinical practice guideline development, it is provider-centered, not patient-centered.
The new guideline could have embraced recent scholarship that indicates the need to provide robust teamwork and medical error avoidance. It could have moved in the direction of improved patient safety and outcomes. Instead, key words are repeated (“communicate,” “collaborate,” “team”) many times, but with no meaningful strategy to achieve their patient safety potential. In fact, within this new guideline, an IONM remote provider’s communication with in-room physician peers and co-practitioners is defined as: “… at minimum, direct voice access (via ‘land-line’ or cellular network) for perioperative communication with the surgical team”.
The evidence for optimized intraoperative...
Stanley A Skinner, M.D.: Director, Intraoperative Neurophysiology Department, Abbott Northwestern Hospital Minneapolis, MN, USA; Endorsed by: Peter Newton, M.D.: Scoliosis Research Society (SRS) President, Paul Sponseller, M.D.: SRS President elect Muharrem Yazici, M.D.: SRS Vice President Todd Albert, M.D.: SRS Past President, On behalf of the SRS; Elif Ilgaz Aydinlar, M.D.: Treasurer, International Society of Intraoperative Neurophysiology, Acibadem University School of Medicine, Department of Neurology, Istanbul, Turkey; Lawrence F. Borges, M.D.: Associate Professor of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Bob S. Carter, M.D., Ph.D.: William and Elizabeth Sweet Professor of Neurosurgery, Harvard Medical School, Head of the Department of Neurosurgery, Massachusetts General Hospital, Boston, MA; Bradford L. Currier, M.D.: Professor of Orthopedics and Neurosurgery, Consultant, Department of Orthopedics, Director, Spine Surgery Fellowship, Mayo Clinic, Rochester, MN, USA; Vedran Deletis, M.D., Ph.D.: Past President International Society of Intraoperative Neurophysiology, Albert Einstein College of Medicine, New York, NY, USA; Charles Dong, Ph.D.: Founding member Canadian Association of Neurophysiological Monitoring, Clinical Associate Professor, Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; John Paul Dormans, M.D.: Chief, Pediatric Orthopedic Surgery, Riley Hospital for Children, Garceau Professor of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Gea Drost, M.D., Ph.D.: Secretary International Society of Intraoperative Neurophysiology, Department of Neurosurgery/Neurology, University Medical Center Groningen, Groningen, The Netherlands; Isabel Fernandez-Conejero, M.D.: President elect International Society of Intraoperative Neurophysiology, Department of Intraoperative Neurophysiology, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain; E. Matthew Hoffman, D.O., Ph.D.: Assistant Professor, Department of Neurology, Mayo Clinic, Rochester, MN, USA; Robert N. Holdefer, Ph.D.: Associate Professor, Department of Rehabilitation Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA; Paulo Andre Teixeira Kimaid, M.D., Ph.D.: President Latin American Chapter International Federation Clinical Neurophysiology, Past President Brazilian Society of Clinical Neurophysiology, Chairman, Intraoperative Neuromonitoring Section, Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil; Antoun Koht, M.D.: Past President American Society Neurophysiological Monitoring, Professor of Anesthesiology, Neurological surgery and Neurology, Chief, neurosurgical anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Karl F. Kothbauer, M.D.: Chief, Division of Neurosurgery, Luzerner Kantonsspital, Associate Professor, University of Basel, CH-6000 Luzern, Switzerland; David B. MacDonald, M.D., FRCP(C), ABCN: Department of Neurosciences, Section of Neurophysiology, King Faisal Specialist Hospital & Research center, MBC 76, PO Box 3354, Riyadh, 11211, Saudi Arabia; John J. McAuliffe III, M.D., MBA: Past President American Society Neurophysiological Monitoring, Professor and Anesthesiologist-in-Chief, Department of Anesthesia, Cincinnati Children’s Hospital, The University of Cincinnati, Cincinnati, Ohio, USA; David E Morledge, Ph.D., CCC-A, DABNM, FASNM, Past President American Society Neurophysiological Monitoring, Neurostatus Eagle, ID USA’Susan H. Morris, Ph.D.: Past President Canadian Association of Neurophysiological Monitoring, IWK Children’s Health Program & Division of Neurosurgery, Dalhousie University Halifax, NS Canada; Jonathan Norton, Ph.D.: Founding member and Past President Canadian Association Neurophysiological Monitoring, Assistant Professor and Clinical Neurophysiologist, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Klaus Novak, M.D.: Dept. of Neurosurgery, Medical University of Vienna, Vienna, Austria; Kyung Seok Park, M.D., Ph.D.: Delegate by Liaison, International Society of Intraoperative Neurophysiology, Professor, Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Joseph H Perra, M.D.: Twin Cities Spine Center, Minneapolis, MN USA; Julian Prell, M.D., P.D.: Credentialing Committee (Co-Chair) International Society Intraoperative Neurophysiology, Martin Luther University of Halle-Wittenberg, Department of Neurosurgery, Halle (Saale), Germany; David M Rippe, M.D.: Neurophysiology Department, Abbott Northwestern Hospital Minneapolis, MN, USA; Francesco Sala, M.D.: Professor and Chairman, Section of Neurosurgery, Dept. of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy; Daniel M Schwartz, Ph.D.: Founding Member American Society Neurophysiological Monitoring, Founder Surgical Monitoring Associates Springfield, PA USA; Martín J. Segura, M.D., Ph.D.: Past President Argentine Society of EEG and Clinical Neurophysiology, Founding member Special Interest Group Neurophysiological Intraoperative Monitoring, Latin-American, Chapter International Federation of Clinical Neurophysiology, Assistant Professor University of Buenos Aires Medical School, Head Clinical Neurophysiology Unit, Hospital Garrahan, Buenos Aires, Argentina; Kathleen Seidel, M.D.: Attending Physician, Intraoperative Neurophysiology and Neuro-oncological Surgery, Department of Neurosurgery, Inselspital Bern University Hospital, Bern, Switzerland; Christoph Seubert, M.D., Ph.D.: Professor of Anesthesiology and Neurosurgery, Chief, Division of Neuroanesthesia University of Florida, College of Medicine, Gainesville, Florida USA; Mirela V. Simon, M.D., M.Sc.: Associate Professor of Neurology, Harvard Medical School, Director, Intraoperative Neurophysiology Unit, Program Director, IONM Fellowship, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Francisco Soto, M.D.: President International Society of Intraoperative Neurophysiology, Neurology Department, Clínica Las Condes, Santiago de Chile; Jeffrey A. Strommen, M.D.: Assistant professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Neurophysiology Department, Abbott Northwestern Hospital, Minneapolis, MN, USA; Andrea Szelenyi, M.D., P.D.: Prof. Dr. Andrea Szelenyi, Past President International Society of Intraoperative Neurophysiology, Clinical and Intraoperative Neurophysiology, Department of Neurosurgery, Hospital of University of Munich, Ludwig Maximilians Universitaet Muenchen (LMU), Munich, Germany; Armando Tello, M.D., Ph.D.: Past President Mexican Society of Clinical Neurophysiology, Founding Member IONM Special Interest Group: Latin American Chapter International Federation, Clinical Neurophysiology, Head, Clinical Neurophysiology Department, Hospital Español, Mexico City, Mexico; Sedat Ulkatan, M.D., DABNM, CNIM: Director of Intraoperative Monitoring Service, Mount Sinai West Hospital-New York NY. USA; Javier Urriza, M.D.: Educational Committee Co-Chair International Society of Intraoperative Neurophysiology, Intraoperative Neurophysiology Unit, Clinical Neurophysiology Deptartment, Complejo Hospitalario de Navarra—B, Pamplona-Iruña, Navarra, Spain; Marshall Wilkinson, B.Sc. (Hons), M.Sc., Ph.D.: Current President Canadian Association Neurophysiological Monitoring, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
No author received funding for the authorship of this commentary.
Compliance with ethical standards
Conflict of interest
Dr. Skinner receives a patent royalty from Medtronic, Inc. No pertinent conflicts of interest are reported.
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