Case Presentation: A 45‐year‐old man with no medical history presented with a 3‐week history of progressively worsening chest pain. The pain was sharp, exertional, and worsened by lying flat. He denied fever, chills, or recent illness. Vital signs were normal, and the only notable exam finding was muffled heart sounds. Initial EKG showed diffuse, concave […]

Background: Overuse of non-ICU continuous adult cardiac (telemetry) monitoring is a well-documented problem that can lead to increase hospital cost, alarm desensitization, nursing time loss, and patient discomfort 1,2. Previous studies assessing reduction of inappropriate telemetry use have employed a combination of electronic health record (EHR) order, nursing protocol changes, intensive educational, and/or feedback initiatives […]

Case Presentation: Patient 1 is a 22‐year‐old man with no medical history who presented with progressively worsening fevers, severe nausea, and nonbloody severe emesis with a diagnosis of infectious mononucleosis. The patient had fevers to 104°F with chills and a pulse of 100. On physical examination, he was ill appearing and diaphoretic. The patient's CBC […]

Background: In order to reduce overuse, many hospitals have conducted studies and implemented protocols with the goal of reducing non-indicated telemetry monitoring. A common tool that institutions utilize for these changes are the clinical decision support systems (CDSS). In this report, we will present the telemetry protocol utilized by our hospital and review its effects […]

Case Presentation: This is a 93‐year‐old woman who presented with a 1‐day history of dyspnea and was subsequently found to have pneumonia. Her medical history was significant for diastolic congestive heart failure, atrial fibrillation, and dementia. The patient had recently been started on furosemide due to worsening dyspnea. A review of systems was positive for […]

Background: The most recent guidelines regarding telemetry monitoring use and indications was published by the American Heart Association (AHA) in 2017.(1) However, most institutions lack evidence-based protocols to guide telemetry usage which could improve overuse. Telemetry monitoring overuse in non-critical patients has been recognized as a contributing factor to healthcare cost, length of stay and […]

Case Presentation: A 24‐year‐old woman presented to our emergency department with right fifth‐finger metacarpophalangeal (MCP) pain. She had a history of overt hyperthyroidism and had self‐discontinued her methimazole several years prior to admission, and had been lost to medical follow‐up. One week prior to presentation, the patient had noticed mild swelling around the joint and […]

Background: Telemetry over utilization increases wasted spending, increases alarm fatigue, and creates patient safety risks. Despite the presence of American Heart Association (AHA) practice guidelines, patients are often placed on telemetry for inappropriate reasons at the discretion of the medical provider and are monitored for longer than anticipated. The goal of this quality improvement project […]

Case Presentation: A 41‐year‐old man with no medical history presented for a second opinion for chest pain, cough, fevers, and an 80‐pound weight loss in 2 months. Previous evaluation revealed peripheral eosinophilia, pericarditis, and pneumonia. On presentation to our facility, his WBC count was 28,000/μL with an eosinophil count of 12,600 cells/μL. A workup was […]

Background: Telemetry beyond 48 hours is indicated for a select patient population and when used inappropriately has risk. This includes increased cost of care, skin irritation, delirium contribution, and more likely to have false positives resulting in errors or extending length of stay.To encourage care that is truly necessary, free of harm, not duplicative, and […]