Sustainability of a Hospitalist Led Intervention to Reduce Length of Stay on Telemetry

Background:

As part of the Choosing Wisely campaign, the Society of Hospital Medicine highlights use of telemetry monitoring as one of the top interventions that physicians and patients should use judiciously.  While telemetry is invaluable when used appropriately, unnecessary telemetry utilization has several drawbacks, including cost as well as potentially reducing patient mobility and ability to rest effectively.  

To address the issue of telemetry utilization, we instituted a multi-level intervention from January 2013 to August 2013 that included the following:  (1) a hospitalist-led, daily review of bed utilization during attending rounds by hospitalists, (2) a hospitalist attending-driven, trainee-focused education module on telemetry utilization, (3) quarterly feedback to hospitalists on telemetry bed utilization rates, and (4) financial incentives.

The goal of this current study is to measure sustaintability of appropriate telemetry utilization post the 2013 intervention and compare telemetry LOS of hospitalists vs non hospitalist attending at a major academic center

Methods:

Using data on all discharges during fiscal year 2015, we compared mean LOS and CMI for patients cared for on hospitalist and non-hospitalist-led teams at a major academic center.  We used 2-tailed t tests.  

Results:

Over the course of fiscal year 2015, among the 2478 patients cared for by hospitalist-led teams, mean LOS on telemetry was 1.89 days.  Among the 1187 patients cared for by non-hospitalist-led teams, mean LOS on telemetry was higher at 2.15 days.  This difference in LOS was statistically significant (p = 0.03).  CMI was not significantly different (p = 0.23) between patients cared for by hospitalists (CMI 1.38) and patients cared for by non-hospitalists (CMI 1.42).  The baseline telemetry LOS from January 2012- December 2012 was 2.75 days. 

Conclusions:

A hospitalist-led multi-level intervention to promote appropriate use of telemetry provides sustainable effects well beyond the time period of the actual intervention. We also show a significant lower telemetry LOS with hospitalists compared to non-hospitalists.