Evaluación de fortalezas y puntos débiles en procedimientos diagnósticos en neurofisiologíaepilepsia, mielopatía cervicoartrósica y síndrome del túnel carpiano en el Hospital Universitario de Burgos. Propuestas de mejora

Abstract

Introduction: In health care, repetitive diagnostic and therapeutic processes are carried out in consecutive groups of patients for whom, often, there are no protocols or those that do exist are not efficient because they are not based on any type of scientific evidence. The lack of protocols leads to erratic referral of patients, unnecessary complementary tests and inefficient management in the use of resources, either in highly prevalent pathologies or other that require time consuming tests for their evaluation. Goals: To evaluate our own clinical practice on the Neurophysiology Department of the University Hospital of Burgos, focusing on the detection of "weak points" in a series of diagnostic processes, using as examples pathologies whose diagnosis requires neurophysiological techniques such as such as video electroencephalography (V-EEG), neurography (ENG) and transcranial magnetic stimulation (TCMS) and somatosensory evoked potentials (SSEP). Interest and applicability: The periodic evaluation and reevaluation of clinical practice leads to maintain proven efficient practices and eliminate those that are not useful and whose performance is carried out by inertia in clinical practice. The identification of weak points allows correction strategies for these and their application in the coming population of patients from the Service itself, resulting in an increase in the quality of care, in saving time, and resources that will lead to reduction of care times. Fields of application: A series of pathologies are selected in which diagnostic procedures are carried out that will be costly, either because of the need for long periods of time for their performance, or because of the frequency with which they are carried out as they are required in very prevalent pathologies. We chose as a paradigm of pathologies in the first group, long-term V-EEG monitoring in patients with drug-resistant epilepsies and the performance of TCMS and SSEP in patients with compressive myelopathies secondary to cervicoarthrosis with surgical indication. As an example of the second group, we selected ENG in patients with carpal tunnel syndrome.