EHR Alert Reduces Excess Cardiac Telemetry in Hospital

Veronica Hackethal, MD

December 11, 2018

An electronic alert embedded in the electronic health record (EHR) safely decreases the length of time that hospitalized patients are on cardiac telemetry, according to a study published online Monday in JAMA Internal Medicine

"This study demonstrates a safe reduction in unnecessary cardiac monitoring using a simple, targeted EHR intervention without the need for intensive human resources or nonenduring educational campaigns," write Nader Najafi, MD, of the University of California, San Francisco (UCSF), and colleagues.  

Telemetry is often used in hospitals to warn doctors and nurses about impending cardiac events. However, the practice is often overused. That can result in "alarm fatigue," as healthcare workers become desensitized to false or irrelevant alarms and stop responding to them.

Other studies have found that multipronged quality improvement interventions may help safely decrease unnecessary cardiac telemetry. However, such interventions can be resource-intensive and complicated to implement.

To test a simpler, less costly approach, Najafi and colleagues conducted a cluster-randomized trial of patients hospitalized on the general medicine service at the UCSF Medical Center. The study included 1021 patients assigned to physicians on 12 inpatient teams (six intervention teams and six control teams). The researchers did not include patients in the intensive care unit, who often require cardiac telemetry.

The intervention consisted of an alert, embedded in the EHR, notifying physicians when they were about to place a telemetry order that would exceed the maximum time recommended by the American Heart Association (AHA) for a patient's given condition. Researchers randomly assigned each team to either receive or not receive the alert. The alert only functioned during the day in order to target primary physicians and to minimize targeting cross-covering physicians at night.

During the course of the study, from November 2016 to May 2017, physicians in the intervention group triggered 200 alerts.

The alert was associated with a significant decrease in telemetry (−8.7 hours per hospitalization; 95% confidence interval [CI], −14.1 to −3.5 hours; P = .001), with a cumulative decrease of 181 days.

Decreased use of telemetry was not linked to changes in rapid-response calls or medical emergencies (rapid response: 6% vs control 5.6%, effect size .004; P = .90; medical emergencies: 2% vs 2%, effect size .0005; P > .99)

Most of the time, physicians responded to an alert by discontinuing telemetry (62%, n = 124). Physicians ignored only 7% (n = 21) of alerts.

The authors note several study limitations. The study took place at a single academic medical center, so results may not apply beyond this setting. In addition to AHA recommendations about the duration of telemetry, the study used the opinion of UCSF experts, which may have been more permissive or included additional conditions that need monitoring.

The study was funded by the Division of Hospital Medicine at the University of California, San Francisco. One coauthor reports working at the University of California, San Francisco, Center for Digital Health Innovation and being the principal inventor of, and receiving potential financial benefit from, CareWeb.

JAMA Intern Med. Published online December 10, 2018. Full text

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