Background:

Alarm fatigue, the phenomenon of desensitization of medical personnel to monitoring alerts, leads to disabled alarms, missed critical events, and increased morbidity and mortality. It is estimated that between 80-99% of alarms are false and/or clinically insignificant. Many hospitals have identified noncritical telemetry use as one strategy to combat alarm fatigue.

We reviewed the rate of non-indicated inpatient telemetry use according to AHA guidelines.  While studies in past have focused on overall use of telemetry which are initiated mostly by the emergency department (ED) on arrival, we aimed to examine telemetry initiated during the inpatient setting.  To our knowledge, this has not been looked at in previous studies.

Methods:

Retrospective medical record review at a tertiary medical center in New York City. 

All medical records for telemetry initiated at least 24 hours after admission to inpatient medicine services, performed between January and December 2013.

Results:

A preliminary analysis was performed for 82 patients. The mean age was 71, 62% were female, and race was roughly 1/3 White, 1/3 African American, and 1/3 Hispanic. Most common comorbidities included hypertension (77%), congestive heart failure (42%), diabetes (34%), coronary artery disease (32%) and atrial fibrillation (18%). 49% of patients were smokers or former smokers.   

A preliminary analysis was performed for  82 patients. The mean age was 71, 62% were female, and race was roughly 1/3 White, 1/3 African American, and 1/3 Hispanic. Most common comorbidities included hypertension (77%), congestive heart failure (42%), diabetes (34%), coronary artery disease (32%) and atrial fibrillation (18%). 49% of patients were smokers or former smokers.  

Adherence to AHA guidelines was noted for 60% of patients. In this cohort, 33% had documented cardiac events, 8% had events that changed management. Cardiology was consulted for 48% of AHA guideline – adherent patients, and 50% of this cohort underwent transthoracic echocardiography (TTE).

Of the 40% of telemetry patients who were non-adherent to AHA guidelines, 18% had recorded cardiac events, 3% had significant events, 30% had cardiology consults, and 36% had TTE performed.

Notably, there was no significant difference between time on telemetry between adherent and non-adherent groups.

Conclusions:

While AHA-indicated telemetry usage was correlated with higher use of hospital resources, non-indicated use was still correlated with significant use of hospital resources, particularly consult services and cardiac testing. While AHA guidelines are meant to aid, not replace clinical judgment in telemetry use, the low rate of cardiac events on telemetry that changed management suggests that telemetry use overall can be more impactful if used more specifically. Institutions should consider interventions such as making hospital specific guidelines and EMR changes related to the ordering of telemetry. Hospitalists should consider the value of telemetry closely before ordering it newly or continuing it when a patient is transferred from another service.