To evaluate whether electroencephalography (EEG) requests to a tertiary hospital neurophysiology department are being made according to National Institute for Healthcare and Excellence (NICE) guidelines.

EEG is a valuable tool in the diagnosis of epilepsy, when used appropriately. To allow for effective utilization of this limited resource, it is imperative that referrals have a clear indication. The neurophysiology department in this tertiary hospital accepts referrals for current inpatients, and outpatients based locally and rurally.

We conducted a retrospective audit of 186 consecutive EEG referrals for 184 patients. All adult patients undergoing EEG between January 1 2022 and March 31 2022 were identified. Data was collected from the patient’s allied health order requisition or referral letter, EEG technical report, and EEG clinical report. Referral indications were compared to NICE guidelines for EEG.

Preliminary results show that 33% of requests did not meet the NICE guidelines for EEG requests, of which 44% had insufficient clinical evidence to justify the use of EEG. EEG contributed to the diagnosis or management of epilepsy in 21% of cases. Inappropriate requests were mainly based on a history of syncope, funny turns, and provoked seizures in the context of alcohol use. Referrals tended to be more appropriate when coming from specialist epilepsy and neurology teams. 

This audit demonstrates that one third of referrals for EEG services at this tertiary center occur outside the scope of NICE guidelines.  This places an additional burden on the service and may contribute to delay in diagnosis, particularly for those awaiting outpatient publicly funded EEG. Additionally, this audit underscores the need for ongoing education across specialist teams to highlight and promote published guidelines in an attempt to improve efficiency of services.