How do I place an order for an electroencephalogram (EEG) in the electronic medical record?

How to Place an EEG Order

The process of placing an EEG order in your electronic medical record (EMR) is institution-specific and requires navigating your local EMR system's order entry module, but the clinical decision-making about when and what type of EEG to order should follow established guidelines.

Understanding the Question

Your question appears to be about the technical process of order entry rather than clinical indications. The evidence provided focuses on clinical guidelines for EEG use rather than EMR navigation instructions. I'll address both aspects:

Technical Order Entry Process

General EMR Order Entry Steps:

• Access your EMR's order entry section (typically labeled "Orders," "Order Entry," or "CPOE")
• Search for "EEG" or "Electroencephalogram" in the order search function
• Select the appropriate EEG type:
  • Routine EEG (typically 20-30 minutes, "spot EEG")
  • Continuous EEG monitoring (cEEG, ≥24 hours)
  • Urgent/STAT EEG (for time-sensitive situations)
• Provide required clinical information:
  • Indication for study
  • Clinical history
  • Urgency level
  • Special instructions if needed

Important Caveat:

Each institution's EMR has different interfaces and workflows 1, 2, 3. Contact your local IT help desk, clinical informatics team, or neurology department if you cannot locate the EEG order in your system.

Clinical Decision-Making: When to Order EEG

Based on consensus guidelines 4, here's when you should order EEG:

Strong Indications (Order Immediately):

1. Acute brain injury with altered consciousness - Order EEG for all patients with unexplained, persistent altered consciousness 4

2. Status epilepticus - Order urgent EEG within 60 minutes if:

   • Patient doesn't return to functional baseline within 60 minutes after seizure medication 4
   • Refractory status epilepticus 4

3. Post-cardiac arrest - Order EEG during therapeutic hypothermia and within 24 hours of rewarming in all comatose patients to exclude nonconvulsive seizures 4

Moderate Indications (Consider Ordering):

1. Unexplained altered mental status in ICU - Order EEG in comatose ICU patients without primary brain injury but with unexplained impairment, particularly with severe sepsis or renal/hepatic failure 4

2. Subarachnoid hemorrhage - Consider EEG to detect delayed cerebral ischemia in comatose SAH patients where neurological exam is unreliable 4

Choosing Between Routine vs. Continuous EEG

Order Continuous EEG (≥24 hours) when:

• Monitoring comatose ICU patients with unexplained altered mental status 4
• Routine EEG misses approximately 50% of nonconvulsive seizures compared to prolonged monitoring 4
• Patient may have cyclic seizure patterns requiring continuous data 4

Order Routine EEG (20-30 minutes) when:

• Initial screening in stable outpatients
• Resource constraints prevent continuous monitoring
• Clinical suspicion is lower

Common Pitfalls to Avoid

• Don't delay urgent EEG orders - In status epilepticus, the 60-minute window is critical 4
• Don't assume convulsive activity is required - Most ICU seizures are nonconvulsive and only detectable by EEG 4
• Don't rely on BIS monitoring as a substitute for EEG in brain-injured patients - data do not support this 4
• Don't order just one routine EEG when continuous monitoring is indicated - you'll miss half the seizures 4

Documentation Support

Modern EMR systems may have structured documentation tools that can help capture EEG results and integrate them into clinical workflow 1, 5. Some institutions have specialty-specific interfaces that streamline EEG ordering and result documentation 5.