Background:
Guidelines for the use of EKG telemetry monitoring for inpatients with cardiac diagnoses, such as myocar‐dial infarction, are provided by the American Heart Association. However, no guidelines exist for its use specifically in patients with medical diagnoses, such as renal failure or pulmonary embolism. This is in large part due to the paucity of data on the use of telemetry in this population. This expensive and resource‐consuming technology is currently used on a medicine service without a clear understanding of its benefit.
Methods:
Over the course of 3 weeks in July 2010 at the University of California, San Francisco Medical Center, all new admissions to the medicine service with EKG telemetry monitoring were logged. Each day the telemetry technician was asked for the names of the patients who were admitted or discharged from telemetry as well as the past 24 hours of telemetry events for all patients in the log. Surveys were then administered to house staff on the day of admission and day of discharge for all patients that were being tracked. The surveys recorded admitting diagnoses, code status, reasoning behind the use of telemetry, cardiac history, recalled telemetry events, and management changes in response to events.
Results:
Sixty patients were tracked during the study period. Fifty‐eight percent had no cardiac history and 22% were DNR/DNI. The most often cited reason for telemetry monitoring was early detection of clinical deterioration. The top 3 new arrhythmias detected on telemetry were: nonsustained VT or PVCs, sinus bradycardia, and sinus tachycardia. One patient developed new atrial flutter. One patient became dyspneic while on monitoring and was found to have developed rapid atrial fibrillation and sustained ventricular tachycardia. This patient was transferred to the ICU. The most common management change in response to telemetry monitoring was the administration of IV fluids.
Conclusions:
Our results suggest that telemetry monitoring usually detects non‐life‐threatening arrhythmias and that more serious arrhythmias may be detected just as often using prompting from symptoms and vital signs alone. Thus, EKG telemetry monitoring may be of less value in medicine patients than current practice suggests.
Disclosures:
N. Najafi ‐ none; A. Auerbach ‐ none