Advancements in technology have expanded accessibility to telemetry via remote monitoring and resulted in increased application in hospitalized patients. The American Heart Association (AHA) telemetry guidelines restrict use to patients with sepsis, severe electrolyte disturbances or primary cardiac conditions. Respiratory infections have emerged as a common source of hospitalization and telemetry is frequently applied without indication. In this retrospective study, we aimed to determine whether telemetry impacts mortality risk, length of stay (LOS) or readmission rates in hospitalized respiratory illness patients not meeting AHA criteria.
Methods:
Vizient ® clinical data from Mayo Clinic Arizona and Mayo Clinic Florida patients admitted with DRGs 193-195, 177 and 178 between 2013-2015 was collected and charts were retrospectively reviewed. Patients were excluded who met 2004 AHA criteria. Patients who did not meet 2004 AHA criteria where then placed in one of two groups 1) telemetry use and 2) no telemetry use during the hospitalization. For categorical variables, chi-square and Fisher’s exact tests were used to compare patients by telemetry use. For continuous variables, t-tests or Wilcoxon rank sum tests were performed. To account for multiple admissions, Generalized Estimating Equations (GEEs) were used to model 30 day mortality, 90 day mortality and LOS. Admission severity of illness (SOI) was included in an adjusted model along with age, telemetry, and gender.
Results:
Demographics
A total of 1262 patients were identified from DRGs 193-195, 177 and 178. Of them, 765 (60.6%) patients did not meet AHA criteria. Telemetry was used in 297 (38.8%) and not used in 468 (61.2%). Both groups were of similar age, gender, race, admission SOI and did not differ by the total number of hospital admissions per patient, number of patients within each DRG or percent of patients admitted through the emergency department (Table 1). Patients without telemetry were more likely to be commercial/private pay (24.9% vs. 17.5%, p=0.019) as opposed to Medicare and were more likely to be treated at the Florida location.
Length of Stay, Readmission Rates and Mortality
Overall, mean LOS was longer in patients who received telemetry (3.8 days vs. 3.2 days, p<0.0001). However, no differences were noted in 30 day readmission rates (0.6% vs 1.3%, p=0.32) or patient mortality at 30 days (7.9% vs. 7.7%, p=0.94), 90 days (13.5% vs. 13.5%, p=0.99), or overall (38.2% vs. 39.7%, p=0.68). On both univariate and multivariate analysis, telemetry was not associated with 30 or 90 day mortality but was associated with increased LOS.
Conclusions:
Respiratory illness patients who receive telemetry without clear indications may face increased LOS without reducing their readmission risk or improving overall mortality.