To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
This role facilitates and participates in the Critical Care Electroencephalography (CCEEG) Monitoring Program at Yale, one of the most advanced and well known in the world. The neurophysiologist reviews and evaluates continuous, raw video EEG recording data which provides continuous brain monitoring for inpatients throughout YNHH and outside hospitals served by YNHHS Neurophysiology Services. This role reports to the leadership of YNHH Neurophysiology in collaboration with the physician leadership of Yale Comprehensive Epilepsy Center and the neurointensivists in the neuroscience ICUs.
This individual will provide technical descriptions and critical care EEG summaries of long-term monitoring studies, including reviewing raw and quantitative EEG obtained during continuous digital video-EEG monitoring. The Neurophysiologist pre-screens Long-Term Monitoring (LTM) studies and alerts responding clinicians to abnormal findings. The Neurophysiologist will further take a major role in technologist and clinical fellow education related to analyzing and evaluating EEG data.
This position will support the development of real-time neurotelemetry, both on the main YNHH campus and remotely from multiple hospitals. This will include supporting and refining workflow, triaging patients, liaising with ordering clinicians and EEG fellows, technologists and attending physicians. It will also include facilitating software set up, networking, and troubleshooting computer issues in conjunction with IT experts as needed, including editing, pruning and archiving studies. There will be opportunities to participate in research including independent projects as desired.
Responsibilities: 1. Responsible for accurately annotating normal and abnormal EEG findings, recognizing artifacts, seizures and seizure-like EEG patterns, subtle seizures, changes in level of consciousness, and EEG patterns of prognostic significance in a variety of medical conditions. 2. Presents EEG/video data and study evolution on daily patient rounds to electroencephalographer/epileptologist, describing current seizures/events including reporting frequency, duration and interictal findings. 3. Independently writes detailed description of EEG patterns, clinical behavior, seizure semiology, and provides preliminary report to electroencephalographer/epileptologist epileptologists and other medical staff. 4. Under appropriate supervision, the neurophysiologist writes reports including pertinent results of previous investigations, current EEG patterns, seizure semiology, mapping results, updated classification, and technical description of ictal and interictal abnormalities. 5. Compiles selection of representative EEG and video clips for presentation in multidisciplinary epilepsy surgical conference as requested. 6. Supports and promotes Yale New Haven Hospital, Yale Comprehensive Epilepsy Center, and the CCEEG/EMU team's goals and efforts. 7. Participates in quality, safety and continuing education initiatives. Supports hospital and Neurophysiology Department goals and objectives through daily staff coaching, mentoring, education and research initiatives. 8. Communicates with management regarding strategic initiatives and opportunities. 9. Alerts appropriate medical staff of any EEG studies requiring urgent attention and/or any additional support for interpretation including but not limited to critical test results.** 10. Contributes to and facilitates required quality assurance/improvement processes, including internal and external audits and review of EEG readings and interpretations. 11. Attends clinical conferences in support of maintaining credentials and certifications along with updating knowledge base and skillset. 12. This individual designs montages, maintains YNHHS Neurophysiology montage library, manages a diverse array of clinical and analytical software tools, and provides required technical support for study acquisition, storage and interpretation. 13. Supports education of new fellows in the assessment and technical description of EEGs. 14. **Critical test results: any values/interpretations where delays in reporting may result in serious adverse outcomes for patients. MA Coalition for Prevention of Medical Errors;
1) PhD degree in a related field preferred.
2) BS or BA degree or higher in addition to the following:
Graduation from a Commission on Accreditation of Allied Health Education Programs (CAAHEP) or Neurodiagnostic Credentialing and Accreditation (ABRET) accredited Neurodiagnostic/Clinical Neurophysiology Program or equivalent.
If PhD, then minimum 1 year of neurophysiology experience in a medical or research environment or equivalent.
If BS or BA, then minimum 3 years of experience in clinical neurophysiology/neurodiagnostics which includes at least 2 years in ICU/CCEEG/LTM long-term monitoring experience preferred.
1. BLS Certification
2. American Clinical Neurophysiology Society (ACNS) ICU Terminology Certification
The qualified non-PhD candidate must have the following in addition to the above:
3. Credentialed in electroencephalography (R. EEG T.*).
4. Credentialed in long-term monitoring (CLTM*).
(Credentials in neurodiagnostics from other nations may also be considered as fulfillment of the credential requirements).
*The R. EEG. T. and CLTM credentials are granted by ABRET Neurodiagnostic Credentialing and Accreditation (ABRET). www.abret.org
This person should have most or all of the "core knowledge" listed in the Neurodiagnostic Societies' (ASET) statement entitled, "National Competency Skill Standards for Performing ICU/cEEG Monitoring", under Section 1, especially these portions listed below, excerpted and modified from www.aset.org., under "competencies":
SECTION I: Critical Care EEG Neurophysiologist CORE KNOWLEDGE
The CCEEG Neurophysiologist:
1. Is highly skilled in EEG pattern recognition and can provide a technical description to the electroencephalographer, physicians, and nursing staff caring for the patient.
2. Possesses knowledge and skills in EEG data reformatting and reduction techniques.
3. Understands computer operations and networking, when applicable, sufficient to do basic troubleshooting/report to information technology support services.
4. Is able to work quickly and proficiently under stressful conditions.
5. Possesses superb oral and written communication in multiple HIPAA compliant formats including but not limited to MHB, EMR, and clinical and surgical databases.
The Critical Care EEG Neurophysiologist is knowledgeable about ICU/cEEG recording and networking options, including:
1. Types of recording and storage media
2. Concepts of digital recording including appropriate sampling rates, aliasing, Nyquist frequency, sampling skew, amplitude resolution and horizontal resolution (analysis time), digital video specifications
3. Effects of recording parameters (filters, gain/sensitivity) on EEG waveforms
4. Electrical safety issues of equipment
This role is accountable to the Co-Directors of the CCEEG Monitoring Program and the Senior Manager Neurophysiology.
The Critical Care EEG Neurophysiologist is accountable for daily oversight and throughput of data review and analysis of the ICU/CCEEG monitoring:
1. Reviews patient's daily chart notes
2. Periodic trending analysis and/or data review
3. Selects CCEEG data for physician review, interpretation and clinical correlation
4. Identifies and accurately describes the chronology of clinical correlates during an event
5. Transfers data between local and network drives from acquisition to review station for data review and permanent storage
The Critical Care EEG Neurophysiologist is responsible for daily communication efficacy and oversight regarding ICU/CCEEG monitoring:
1. Periodic update to attending physicians and nursing staff per policy and procedures.
2. Periodic data analysis update to the electroencephalographer regarding CCEEG and patient clinical condition per policy and procedures.
3. Alerts ICU team to the possible occurrence of non-convulsive and/or convulsive seizure activity recorded during the monitoring period reviewed per policy and procedures.
4. Reports critical test results to the interpreting physician, nursing staff, and/or supervisor and documents this communication according to facility policy and procedures.
Routinely reviews CCEEG monitoring recordings with the attending electroencephalographer and assigned fellow to ensure quality oversight and alignment with Yale Comprehensive Epilepsy Center and Neurophysiology Department Standards.
The CCEEG Neurophysiologist comprehends:
a) Principles of critical care monitoring and relevant clinical application as reflected in current literature
b) Medical terminology and accepted abbreviations in ICU/CCEEG
c) Electronic concepts relative to ICU/CCEEG equipment and patient safety
d) Functional neuroanatomy and neurophysiology relevant to critical care monitoring
e) Anatomical correlation of EEG waveforms
f) Electrophysiologic correlates of clinical conditions found in critical care patients such as: convulsive and nonconvulsive seizures, altered levels of consciousness, coma, sedation titration, vasospasm, intracerebral hemorrhage and encephalopathy
g) The utility of current medications used in critical care; their clinical and electrophysiologic effects
h) Indications for ICU/CCEEG.
1. Frequent walking 25-75%
2. Sitting/standing 67-100%
3. Reaching including above/below shoulder height 33%
4. Some kneeling/crawling 5%
5. Pulling/pushing >50 pounds 10%
6. Carrying 7. Frequent bending /stooping/crouching/twisting and continuous repetitive movements
Lighting bright and dim, mechanical hazards, hazardous substances, infectious diseases and toleration of temperature ranges 60 to 75 degrees Fahrenheit.
Physical Ability: Must be good or greater: vision, hearing, manual dexterity, talking, speech, and typing.
Requires the ability to concentrate for long periods of time under stressful conditions and still perform properly and effectively.
The Neurophysiologist job description does not supersede governmental regulation and/or
state licensure laws or affect the interpretation of such laws if they so exist.