Abstract and Introduction
Abstract
Objectives: Telemetry is frequently overused in hospitals. The goal of this study was to evaluate a telemetry protocol aimed at decreasing inappropriate telemetry utilization across four different hospitals within a large healthcare system by modifying the electronic telemetry order to incorporate the 2017 American Heart Association practice guidelines on the appropriate use of telemetry and using an electronic nursing screening task form to safely discontinue telemetry.
Methods: We performed a retrospective analysis of telemetry utilization before and after we implemented a protocol across four hospitals within a large healthcare system. We compared the average number of days of telemetry monitoring and hospital length of stay during the preintervention period with the 6-month postintervention period.
Results: There were a total of 23,774 encounters evaluated. There was a statistically and clinically significant 24% decrease in telemetry duration between pre- and postintervention time periods (P < 0.0001). The mean (standard error) telemetry duration was 4.11 (0.17) and 2.36 (0.13) days in pre- and postintervention periods, respectively.
Conclusions: The results of our study demonstrate a statistically significant decrease in overall duration of telemetry monitoring by nearly 1.75 days across each of the four hospitals with the implementation of a multifaceted telemetry protocol that included hardwiring the American Heart Association practice guidelines into the electronic order and using a nursing-driven discontinuation protocol.
Introduction
Continuous cardiac monitoring, or telemetry, is a valuable tool that is used frequently in hospital settings to monitor patients for a multitude of reasons, including the detection of life-threatening arrhythmias. The American Heart Association (AHA) published guidelines updated in 2017 that outline indications and the duration of appropriate telemetry usage.[1] Despite these guidelines, telemetry often is ordered for indications that fall outside appropriate usage. In addition, telemetry often is continued throughout the hospitalization once ordered. Approximately 43% of monitored patients do not have an indication for telemetry supported by the guidelines.[2,3] Furthermore, studies suggest that cardiac monitoring rarely leads to overall changes in clinical management or the ability to identify patients at risk for clinical decompensation.[4,5] Inappropriate utilization of telemetry leads to wasted resources, increased healthcare costs, and can result in alarm fatigue and potential patient harm.[6]
A few recent studies have implemented strategies at improving the overuse of telemetry monitoring. The High Value Practice Academic Alliance also has published guidelines to help health systems develop and implement systemic changes, including changes to the electronic telemetry order set, telemetry use education, and a programmed discontinuation protocol.[7]
Pilot studies investigated telemetry usage across our healthcare system and showed that 27% to 40% of patients monitored on telemetry do not meet the criteria for monitoring based on the AHA practice guidelines. The majority of patients continue to be on telemetry monitoring until the time of discharge and the decision to discontinue telemetry is solely based on when the provider (physician, resident, or advanced practice provider) enters the discontinuation order in the electronic ordering system. We identified implementation of a telemetry clinical decision-making tool within the electronic health record (EHR) as an area of quality improvement to reduce telemetry overuse and associated healthcare cost.
South Med J. 2022;115(12):930-935. © 2022 Lippincott Williams & Wilkins
