Background: Telemetry is an often overused and expensive medical monitoring device designed to measure cardiac disease, arrhythmias or suspected heart abnormalities. In an effort to describe appropriate electrocardiographic monitoring in the hospital setting, the American Heart Association (AHA) put forth guidelines for appropriate telemetry usage. Despite these well-defined recommendations, many patients are monitored on telemetry for unnecessary indications. There are consequences to telemetry monitoring overuse such as increased maintenance needs and supplies, augmented medical costs related to extra nursing requirements with specialized training, and prolonged emergency wait times due to telemetry box shortages. Efforts to safely and effectively decrease telemetry utilization need to be further explored to decrease healthcare costs and provide more appropriate care for our patients. The goal with this research project was to establish the utilization patterns of telemetry of the Internal Medicine teaching service, and determine if bringing attention to the AHA guidelines would decrease telemetry use.
Methods: The study took place in two phases: pre-intervention and intervention. Each phase measured the number of patients on the Internal Medicine Residency service that were either admitted to or transferred to a non-intensive care unit telemetry bed during a thirty-day period. The 2004 AHA standards for Electrocardiographic Monitoring in addition to hospital-wide protocols were applied to determine the number of indicated and non-indicated days patients were monitored on telemetry. In the intervention phase, the resident teams where provided with the criteria. There was also a one-time education session, which went over the indications for telemetry on admission and the indications for telemetry discontinuation. Pre-intervention and intervention total numbers were compared using a T Test to determine if there was a significant reduction in the overall non-indicated telemetry days.
Results: When comparing the pre-intervention phase to the post-intervention phase the total number of non-indicated telemetry days decreased by 18.4%. This was demonstrated to be a significant decrease with a p value = .003. There was no significant decrease in indicated telemetry days.
Conclusions: By bringing attention to the AHA guidelines, the total number of non-indicated telemetry days was effectively decreased, while the number of indicated telemetry days was not significantly affected. This means that patients with an indicated need still received appropriate monitoring, while those who did not meet a telemetry indication did not. With patients being appropriately monitored on telemetry this could decrease the amount of time patients spend on telemetry during their stay with overall hospital health care savings and decrease adverse events.