The Practice of Telemetry in Non‐Icu Beds at a Community Hospital,a Quality Improvement Study

Background:

Telemetry monitoring is often overused in inpatient setting. This has led to overcrowding of telemetry beds, increasing boarding time in emergency department, and inefficient distribution of limited hospital resources. Furthermore, telemetry has impact on patient’s activity level and de conditioning, and subsequently increasing the length of stay.

Methods:

We did a prospective follow up of 130 patients admitted to the telemetry floor at a community based hospital, between January 2013 and February 2013. After obtaining IRB approval, charts were reviewed on daily bases to obtain demographic characteristics of the patients, indications of telemetry, daily follow up of telemetry events, length of stay of the patients, and discontinuation rate of the telemetry orders.

Results:

Out of 130 patients (48% male) of these patients were males, the documented indications were, ACS 28 (21%), No order documented 21 (16%),CVA and syncope 20 (15%), Arrhythmia 17 (13%), CHF exacerbation 14 (11%),GI bleed 8 (6%),Hypo &Hperkelemia 4 (3.07%),Sepsis 4(3.07), Pulmonary embolus 3(2.3%), drug toxicity 1 (0.7).Indications not pre specified in EMR 6 (4.5%) . The event rate requiring specific new intervention (administer a new drug, asking for consult, or performing a procedure was 18(13.8%). The rate of uneventful telemetry was 112 (86.2%) patients. The average length of stay was 6.3 days, and the average time of telemetry monitoring was 4.5 days. Telemetry was discontinued 24 hr or less prior to discharge in 38 (29.2%) of patients. According to American College of Cardiology, guidelines for telemetry in hospitalized patients (1), 90 (69.3) of our patients were Class II indication (may be indicated), 40 (30.7) patients were class III indication (not indicated), and none was Class I indication (indicated in nearly all patients), as most of these indications requires ICU admission. The low discontinuation rate before discharge is a powerful indicator that the indications of continuing telemetry monitoring in our telemetry unit were not often reviewed during hospitalization.

Conclusions:

Telemetry beds are overused in our hospital. Improving provider awareness for standard telemetry guidelines might promote compliance, eases the burden on limited availability of telemetry beds, thereby improving the quality of care. We suggest reviewing of telemetry indications routinely during daily rounds, and to include this reminder in the Electronic Medical Records.