Patients at high risk for cardiac events often receive telemetry, however, overutilization of cardiac monitoring leads to unnecessary interventions and increased healthcare costs. The American Heart Association (AHA) recommends classification of cardiac risk via symptoms and clinical course for determining telemetry needs as Class I, II, or III from highest to lowest risk respectively. We investigated whether an education initiative improves classification of cardiac risk and appropriate use of telemetry in the medical/surgical floor at a community medical center.
Methods:
We studied data from 300 randomly selected patients treated at Christus Highland Medical Center. Hospitalists, emergency room providers, and nurses received educational lectures, posters, flyers, and e-mails on proper classification of cardiac risk and indications of telemetry use per AHA guidelines during August 2015. Data was captured from 150 patients treated during pre-intervention (April to May 2015) and 150 patients treated during post-intervention (September to November 2015). Telemetry was defined as appropriately indicated for class I & II, and not indicated for class III. Comparisons were performed via chi-square and Wilcoxon rank-sum tests.
Results:
Patients in the pre- and post-intervention groups had a mean age of 66 and 67 years (p=0.3), 45 and 47% male (p=0.5), and length of stay of 3.15 and 2.73 days (p=0.5), respectively. From pre- to post-interventional period, there was a 6.66% increase in appropriate telemetry use in class I & II patients, and a 6.67% decrease in inappropriate telemetry use in class III patients. There was a 0.86 day reduction in mean length of telemetry use (p=0.005) and 0.94 day decrease for excess telemetry use (p=0.003) from before to after the intervention. The cost benefits of the reduced overutilization of telemetry at our hospital was $240 per patient per day.
Conclusions:
Our results indicate that inexpensive and scalable provider educational interventions can be effective for healthcare management staff to utilize for improving the appropriate utilization of telemetry services. AHA guidelines can be used to create provider educational interventions for cardiac risk classification and indicated use of telemetry, which have potential to improve utilization of resources and reduce cost of care.