From the 2019 HVPAA National Conference
Dr. Fatima Shahid (University of Rochester)
Background
An estimated $250,000 is spent on unnecessary cardiac monitoring in an average hospital annually. In 2004, the American Heart Association (AHA) published guidelines for cardiac monitoring, yet physicians continue to place patients on telemetry when it is not indicated. Overuse of telemetry results in waste, over treatment, patient discomfort and alarm fatigue.
Objective
Multidisciplinary quality improvement project aimed to reduce inappropriate telemetry use on a Hospital Medicine floor over 3 months by implementing a “telemetry huddle”.
Method
Baseline data was collected between November 2018 to February 2019 to assess telemetry usage and appropriateness for patients on a hospital medicine floor at Strong Memorial Hospital, Rochester, New York. A multidisciplinary intervention the “telemetry huddle” was implemented starting February 2019. It includes bringing up the telemetry status and whether or not it is required for every patient on telemetry during the multidisciplinary morning rounds by the nurse manager or care coordinator. This is then followed by a reminder page at the end of the day for patients who do not require telemetry anymore. Data collection for the intervention is ongoing. Strong Memorial Hospital Cardiac Monitoring Guidelines which are in line with the updated AHA 2017 guidelines for cardiac monitoring are being used to assess the appropriateness of telemetry usage.
Results
According to the baseline data 12% (N = 3.11 patients/ day) of the patients on the hospital medicine floor were on telemetry on average during the 2 month survey period. After intervention this proportion dropped to 9% (N = 2.25 patients/ day). The number of patients on telemetry during study period is shown in Figure 1.
Conclusion
A significant proportion of general medicine patients are placed inappropriately on telemetry. This occurs despite institutional-level interventions to incorporate telemetry indications into the telemetry order. The physician culture of ordering telemetry as a safety net, lack of awareness of telemetry status, and limited knowledge regarding telemetry guidelines contribute to overuse. Our intervention aims to increase physician awareness of telemetry status by initiating a discussion regarding the appropriateness of its usage through a multidisciplinary approach. If effective this is a low effort, high impact intervention that is easily reproducible.
Clinical implications
Lack of provider awareness regarding patients’ telemetry status contributes to inappropriate telemetry use. This results in a waste of resources and alarm fatigue. A multidisciplinary approach involving physicians, nursing staff and other health care providers is key to tackling this efficiently and effectively.
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