Improvising Telemetry Use in a Rural Teaching Hospital: A Choosing Wisely Initiative

Background: Cardiac telemetry use has expanded in the last 30 years. Inappropriate telemetry use leads to prolonged hospital stays, patient discomfort, and increased healthcare costs. As part of SHM’s choosing wisely campaign, we designed and implemented a revised telemetry electronic health record (EHR) ordering system in an attempt to increase appropriate telemetry use in non-intensive care unit (ICU) setting.

Methods: We did a literature search on guidelines for telemetry indications and made a new conscised list of telemetry indication. We then took out the telemetry order set from the general admission order set and made it a separate entity. We made it compulsory for admitting physicians to pick one of the indications from the order set. Additionally, we allowed physicians to order telemetry for patients not meeting criteria in the order set but they were required to text in the indication in the other tab. Baseline data was collected for all hospital admissions at our institution prior to our revised EOS( Electronic Ordering System) implementation. Admitting physicians including hospitalists and residents were informed about the new modification in the EOS.

Results: We collected and analyzed data from November 2016 to September 2017. Pre and post intervention telemetry ordering rates were 63.79% and 46.84% per month respectively. Our intervention resulted in a large (16.95%) decrease in telemetry ordering. Cost analysis revealed 61 telemetry-beds saved per month. This was done without any change in the rate of code blue or rapid response team activation.

Conclusions: With the impetus of health reforms and growing urgency for hospitals to improve efficiency and reduce costs, it is high time to examine high volume practices to identify potential overuse. This physician driven intervention to improve appropriate use of telemetry led to reduced cost and increased knowledge of cost saving actions among physicians. In addition, this led to reduced staff time and effort while maintaining patient safety. Future efforts will include the implementation of a telemetry auditing tool, whereby each day use of telemetry will be discussed during the rounds.