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 guideline development, it is provider-centered, not patient-centered. The new guideline could 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 safety and outcomes. Instead, key words are repeated (“communicate,” “collaborate,” “team”) many times, but with no meaningful strategy to achieve their patient safety potential. 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”.