ECT practices in the community

By
J. Prudic, M. Olfson, and H.A. Sackeim

Summary

Background: Controlled studies have demonstrated that ECT technique impacts on the efficacy and cognitive side effects. However, there is little information on the extent of variation in how ECT is practiced in community settings.

Introduction: Good quality of care implies provision of care that is technically competent. Due to concerns about the possibility of widespread use of suboptimal technique, the national Institutes of Health Consensus Conference Panel called for a National survey of ECT practice in the U.S. This was never performed.

Methods. A survey of practice patterns was conducted at ECT facilities in the greater New York City metropolitan area,

Findings:

The majority of patients were greater than 60 years of age.
The forms of ECT administered varied considerably (eg. 11% of patients received sine wave stimulation; approximately 75% were treated with bilateral ECT)
EEG monitoring was not used in 14% of the facilities
Monitoring of the motor seizure with the cuff technique was not conducted in 53% of the facilities
There was considerable variability in whether patients were routinely evaluated with respect to cognitive status, before, during, or after ECT.

Discussion. The marked departures from the field’s standard of care and the wide variability in how ECT is conducted undoubtedly raise public health concerns. This study did not audit actual practices, but relied on the report of the Directors of ECT Services … discrepancies were found between the survey results and the review of the medical records. The results of this chart review suggested that if there were a bias in the findings of the survey, it was in the direction of the reports by ECT service directors being more in line with guideline recommendations than the actual practices of the facilities.

Conclusion: There is marked variability in the nature of ECT practices in community settings. The extent to which this variability impacts on the benefits and risks of ECT needs to be examined.

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