Background: Inpatient telemetry monitoring began over 4 decades ago. However, recently hospitals have started to implement programs that aim to improve the appropriateness of telemetry use. Quality initiatives take the American Heart Association (AHA) guidelines for practice standards for EKG monitoring in hospital settings to reduce the numbers of patients on telemetry inappropriately.  Our residency program performed a gap analysis and learned that many of our residents are not aware of the current guidelines for telemetry use and are often using telemetry inappropriately. Thus, it became clear that the program needed an assessment of the current telemetry use patterns as well as subsequent targeted education about the AHA guidelines.

Purpose: The purpose of this project was to identify telemetry usage patterns and improve compliance with AHA guidelines. The ultimate goal is to improve compliance with AHA guidelines hospital wide. Thus, prior to implementing a large scale change, we wanted to assess usage in a smaller group to understand the scope of the final project.  Finally, based on usage patterns we wanted to develop relevant educational materials to provide physicians throughout the hospital with appropriate recommendations for telemetry use. A post-implementation analysis was  also developed to measure success at a future time period.

Description: During a quality improvement workshop, residents identified that they often have trouble determining which patients should be on telemetry monitoring.  Research was conducted to see what guidelines on appropriate telemetry were available and also to see what other institutions have implemented to improve their telemetry use to meet current guidelines. 4 inpatient medicine resident teams were surveyed to determine what percentage of patients on telemetry meet the AHA criteria. Based on the survey results, it was clear that more than 40% of patients are placed on telemetry inappropriately. Thus, an educational lecture was created during which residents were informed of their results as well as the current guidelines.  Residents were asked to use the AHA guidelines for future telemetry orders. A post-implementation matrix was designed to evaluate resident usage in 6 months.

Conclusions: Internal medicine residents need additional education about the AHA telemetry guidelines. Resident run quality initiatives are an excellent way to bring residents to the forefront of solving challenging problems within hospital systems.  By giving residents a basic education about quality improvement, they are able to design and implement successful QI projects and elicit meaningful change for patients.