Purpose: To develop a new computerized acute care telemetry order set and continuation protocol based on AHA recommendations and to characterize provider knowledge and application of AHA recommendations and determine impact on utilization.
Description: At a single academic center, hospitalists, telemetry-trained nurses, and housestaff were surveyed to assess awareness of AHA recommendations, knowledge of indications, and appropriateness of continuation in five clinical scenarios. After survey completion, the telemetry order set was updated to require providers to select a specific indication categorized by recommended duration of use (Figure 1). The system was updated to automatically page providers with a recommendation to discontinue telemetry if length of use exceeded the recommended duration.
18 hospitalists, 69 nurses, and 42 medicine residents completed the survey. 33% of hospitalists, 16% of nurses, and 33% of housestaff reported awareness of AHA recommendations. Hospitalists, nurses, and housestaff correctly identified AHA indications in 72%, 62%, and 59% of cases respectively and correctly determined appropriate continuation 67%, 74%, and 75% of the time.
Since system implementation four months ago, the average number of hours that patients remain on telemetry has decreased from 58.3 to 48.2 (p=0.01) overall. Among hospitalists, this time did not change significantly (mean 50.1 hours prior compared with 49.7 hours after), however, among residents, average time decreased from 70.0 hours per patient to 44.7 (p=0.003), a 36% decrease. The percent of patients who had telemetry monitoring actively discontinued prior to discharge increased significantly in both groups from 61% to 76% among hospitalists and 63% to 80% among residents. (p < 0.01).
Conclusions: Most providers were not aware of AHA recommendations for acute care telemetry use. Compared with nurses and housestaff, hospitalists were most likely to correctly identify AHA-recommended telemetry indications but were less likely to identify appropriate telemetry continuation. An updated telemetry order set and automatic discontinuation reminder resulted in decreased utilization with fewer hours of use per patient and increased early discontinuation. A follow-up survey of provider knowledge and analyses of utilization by indication stratified by provider type over a longer time period are planned.