Background: Telemetry is overused in hospitals and continues to be a significant source of health system waste. It is considered a leading issue in quality initiatives, as highlighted by its presence in the top five recommendations by the Society of Hospital Medicine to the ABIM Choosing Wisely Campaign. The overuse of telemetry is likely due to physician uncertainty regarding patient trajectory, unawareness of established indications, and a misconception that telemetry imparts a higher level of care. Inappropriate use leads to increased costs, emergency department backups, unnecessary work up of insignificant arrhythmias, and patient discomfort. We conducted a study to evaluate the use of telemetry at UCLA-Santa Monica Medical Center and the effect of an educational intervention on telemetry utilization.
Methods: We studied the admissions of UCLA Internal Medicine residents rotating through the hospitalist rotation at UCLA-Santa Monica Medical Center from 11/21/14 – 5/7/14 (6 blocks). Data on admissions were collected discretely by post-call nurse practitioners who recorded admission diagnosis, telemetry status, and telemetry indication. For 3 of the 6 blocks, half the residents on the rotations received an educational intervention on telemetry indications and received a pocket card with guidelines. We reviewed all telemetry admissions that had unclear indications and deemed them appropriate or not based on published guidelines. We also conducted a program-wide survey on Internal Medicine resident opinions of telemetry use and comfort with indications.
Results: Data on 642 admissions was collected, and of these admissions, 52% (333/642) were put on telemetry. Of all telemetry admissions, 34% were deemed inappropriate (112/642). With no intervention, 56% of admissions were put on telemetry whereas with intervention, 40% were put on telemetry (p=0.0004). In addition, without intervention, 63% of telemetry admissions were appropriate, whereas with intervention 79% of admissions were appropriate (p=0.0135). The intervention group was 2.24 times more likely to admit appropriately to telemetry than those that did not receive the intervention (p=0.0151). Of the residents who responded to the survey (74/113), 92% felt that telemetry is overused, and 72% felt they personally overused telemetry.
Conclusions: Our study showed that telemetry was overused by the Internal Medicine residents at UCLA-Santa Monica Medical Center, however a relatively simple and inexpensive educational intervention significantly reduced inappropriate use. These results translate to a significant reduction in cost and waste of resources. In addition these interventions appear to be favorably received by residents based on their survey responses. Future directions include a program-wide telemetry intervention, guideline integration into our electronic health record program, and a telemetry discontinuation study.