Is the new ASNM intraoperative neuromonitoring supervision “guideline” a trustworthy guideline? A commentary

The new ASNM intraoperative neuromonitoring (IONM) supervision guideline[1] attempts to justify current remote IONM practices.1 Contrary to ordinary clinical practice guidelinedevelopment, it is provider-centered, not patient-centered. The new guidelinecould have embraced recent scholarship that indicates the need to provide robust teamwork and medical error avoidance. It could have moved in the direction of improved patient safetyand outcomes. Instead, key words are repeated (“communicate,” “collaborate,” “team”) many times, but with no meaningful strategy to achieve their patient safetypotential. In fact, within this new guideline, an IONM remote provider’s communication with in-room physician peers and co-practitioners is defined as: “… at minimum, direct voice access (via ‘land-line’ or cellular network) for perioperative communication with the surgical team”.