S02 D.2 Intraoperative Neuromonitoring Communication Log _ Sample.docx
DOCX document 23 KB Posted
- Attached to
- Q523--Intraoperative Neuromonitoring (IONM) Services South Texas Veterans Health Care System
- Solicitation number
- 36C25726Q0274
About this file
This is a template and sample documentation for an Intraoperative Neuromonitoring (IONM) Communication Log used to record real-time neural monitoring data during surgical procedures. The document does not address specific contract requirements, deliverables, pricing, or service terms; rather, it serves as an operational tool for medical professionals to document baseline neurophysiological data, monitor changes during surgery, and communicate critical events to the surgical team.
The template demonstrates standardized documentation of neuromonitoring modalities including Somatosensory Evoked Potentials (SSEP), Motor Evoked Potentials (MEP), and Free-Run Electromyography (EMG) during a lumbar spinal fusion procedure. The sample case illustrates the communication protocol between technologists and physicians, event documentation procedures for significant waveform changes exceeding 50% amplitude reduction, immediate clinical responses such as retractor adjustment, and final case summaries confirming resolution of transient changes with no lasting neural compromise. This template appears designed to establish consistent documentation practices and communication protocols for IONM service delivery to the South Texas Veterans Health Care System under Solicitation 36C25726Q0274, but the document itself does not contain solicitation-specific requirements, timelines, pricing structures, or contractual terms.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25726Q0274 0001.docx | DOCX document | |
| D.8 PAST PERFORMANCE SURVEY 36C25726Q0274.docx | DOCX document | |
| S02 D.6 Contractor Certification - Immigration and Nationality Act.docx | DOCX document | |
| S02 D.5 Contractor Rules of Behavior.docx | DOCX document | |
| S02 D.4 VHA Directive 1088 Communicating Test Results to Providers and Patients.pdf | ||
| S02 D.7 Organizational Conflicts of Interest.docx | DOCX document | |
| S02 D.1 QASP Neuromonitoring.pdf | ||
| 36C25726Q0274_1.docx | DOCX document |
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Text version
D. 2 Intraoperative Neuromonitoring Communication Log – Template & Example
Case Information
| Field |
| Details |
| Case ID |
| 2026-IONM-078 |
| Date |
| 06/30/2026 |
| Procedure |
| Lumbar L4–L5 Decompression and Fusion |
| Surgeon |
| Dr. M. Alvarez |
| Anesthesiologist |
| Dr. R. Chen |
| Technologist |
| K. Daniels, CNIM |
| Supervising Physician |
| Dr. L. Carter, MD, DABNM |
1. Baseline Data
· Start Time: 07:58 CST
· Modalities Monitored: SSEP, MEP, Free-Run EMG
· Baseline Waveform Summary:
· SSEP:
· Upper extremities: Amp 2.8 μV, Lat 19.5 ms
· Lower extremities: Amp 2.1 μV, Lat 38.2 ms
· MEP: Present in all monitored muscle groups; amplitudes 800–1200 μV
· EMG: No spontaneous activity at baseline
2. Communication Log Table
| Time |
| From |
| To |
| Event / Observation |
| Waveform Details |
| Action Taken |
| Outcome |
| 07:58 |
| Tech |
| Physician |
| Baseline obtained |
| SSEP & MEP WNL |
| None |
| Stable |
| 08:42 |
| Tech |
| Physician |
| Left tibialis anterior MEP amplitude ↓ ~60% |
| Baseline 950 μV → 380 μV |
| Alert surgeon |
| Retractor adjusted |
| 08:45 |
| Tech |
| Physician |
| MEP improving |
| 380 μV → 720 μV |
| Continue monitoring |
| Returned to 95% baseline |
| 09:30 |
| Tech |
| Physician |
| Brief EMG burst in right gastrocnemius |
| 200 ms train |
| Surgeon notified |
| EMG quiet |
| 11:05 |
| Tech |
| Physician |
| All modalities stable |
| No changes |
| None |
| Stable |
| 12:12 |
| Tech |
| Physician |
| Final SSEP & MEP stable |
| No latency/amplitude changes |
| Approve report |
| Stable |
3. Event Documentation
· Significant Change Criteria: >50% MEP amplitude drop
· Event Description: At 08:42, left tibialis anterior MEP amplitude decreased by ~60% from baseline.
· Immediate Actions: Alerted supervising physician and surgeon; surgeon paused, irrigated, and adjusted retractor.
· Surgeon Response: Retractor repositioned; surgical field inspected for compression.
· Follow-up Monitoring: MEP amplitude improved to 95% of baseline within 3 minutes.
· Resolution: No further changes noted for remainder of case.
4. End-of-Case Summary
· Final Waveform Status:
· SSEP: Stable, no latency or amplitude changes
· MEP: Stable, all muscle groups present and within baseline range
· EMG: No sustained activity
· Overall Interpretation: ☑ No significant lasting changes
· Physician Final Statement: “Transient MEP change resolved intraoperatively; no evidence of permanent neural compromise.”
Signatures
· Technologist: _____________________ Date: ___________
· Physician: ________________________ Date: ___________
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