Last fall, clinical teams across Alta Bates Summit Medical Center and Sutter East Bay Medical Foundation submitted funding proposals to the East Bay philanthropy teams’ inaugural Grants and Disbursements Program. Physicians, nurses, program managers, researchers and executives pitched their ideas for improving patient care, including new technologies, programs and upgrades, to philanthropy board members. The panel then selected the most critical initiatives to support with community gifts and employee donations.
Ultimately, 35 proposals received grants totaling more than $250,000. Here is a look at some of the initiatives made possible by your generosity.
Cerebell EEG Monitoring Equipment
Nonconvulsive seizures — electrical discharges in the brain that have few if any outward physical manifestations — are not uncommon in critically ill patients. “There is no jerking, stiffness, tongue biting or other outward signs we usually associate with clinical seizure,” says Randall Starkey, M.D., SEBMF neurologist and EEG medical director at ABSMC. Nonconvulsive seizures occur in a range of patients, he adds, including those who have had a heart attack or have head trauma, an infection such as encephalitis or meningitis, or a history of epilepsy.
“The real issue has been that we’re not aware nonconvulsive seizures are happening, which typically leads to a poor prognosis,” Dr. Starkey says. “If electrical seizure activity persists for an hour or more, it can result in some permanent brain damage.”
The only possible way to detect a nonconvulsive seizure is to catch it while recording the electrical activity of the brain. That’s precisely what routine electroencephalogram (EEG) does; however, this type of EEG, which has been available for years, is rarely used for continuous monitoring. Consequently, it has little value in detecting otherwise unrecognized seizures.
“We could use routine EEGs for more prolonged recordings, but the machines are typically not available for long periods of time,” Dr. Starkey explains. “They are bulky, cumbersome and expensive, so intensive care units are usually unable to keep several on hand. Also, obtaining a routine EEG recording requires specific training, and there is a significant shortage of qualified technicians. So, due to these limitations, we usually cannot keep an EEG on a single patient for much more than an hour.” Monitoring for nonconvulsive seizures, he notes, may take much longer.
Another frequent dilemma is when ICU patients have an alteration of consciousness or awareness and caregivers don’t know why. “Some may be in nonconvulsive seizure status, meaning their seizures are continuous or quite frequent,” Dr. Starkey says. “We’ve also found that in patients who don’t wake up for reasons we can’t identify, up to 25% may be having intermittent seizures with no clinical manifestations. There was previously no real way of checking.”
Fortunately, thanks to the East Bay’s inaugural Grants and Disbursements Program, that has changed at ABSMC. Awarded a $10,000 grant, the ICU care teams at both campuses now possess revolutionary EEG technology that provides seamless, continual monitoring of patients’ electrical brain activity. Ceribell Rapid Response EEG consists of a pocketsize recorder and a simple headband that can be administered by any caregiver in under five minutes — no formal EEG training required. ABSMC brought in two units in early November 2020 and another two this spring, providing two per ICU.
“Ceribell can be run for a much longer period of time, partly because, unlike traditional EEG machines, it doesn’t need to be taken away for use on another patient,” Dr. Starkey says. “Also, it can send brain-wave data in real time via the internet to an interpreter anywhere to be read immediately. Although most routine EEGs can also be read from a distance, you usually have to download the data to a server first, so there is a delay, preventing realtime interpretation.”
Another benefit of Ceribell is that, for patients who’ve had clinical seizures treated with medication, doctors can now monitor for lingering electrical seizure activity and provide further treatment if necessary. “For years, we would treat patients so that, clinically, their seizure went away,” Dr. Starkey explains. “But unless the electrical seizure activity also goes away, the medication is of much less benefit.”
He says it’s difficult to pinpoint just how many lives Ceribell has positively affected in the ABSMC ICUs so far. However, studies have shown that having access to continuous EEG can improve patient outcomes by 30% to 50%.
“Philanthropy has been a godsend,” Dr. Starkey says. “Before, you had to be an academic institution or other epilepsy monitoring unit to offer continuous EEG, or have multiple big machines and a large staff of EEG technologists paid to take calls. Now we don’t need any of that, and we get virtually the same vital information about patients’ brain activity.”