From the 2022 HVPA National Conference
James Grace (Medical Doctorate, University of Minnesota Medical Center)
As much as 20% of health care spending is waste. As cost of care increase, so must efforts to decrease unnecessary resource utilization increase. One area that has been identified is inpatient cardiac monitoring, or telemetry. There is such wide and varied use of telemetry that practice standards to guide its use have been published. Adherence to the practice standards has been shown to be poor.
2,119 records of every adult inpatient in the health system for the month of June 2021 were reviewed for telemetry orders. Patients admitted under observation status or admitted to the ICU were excluded. These orders were compared the to the published practice standards for both indication and time on telemetry. Orders were said to meet the practice standards if the indication was appropriate and the order was discontinued, or the patient was discharged, within the recommended timeframe. Excess hours of telemetry were calculated by subtracting the maximum time indicated in the practice standards from the total time on telemetry. For indications that were not included in the practice standards, zero hours was used as the maximum time indicated.
31.5% of Inpatient telemetry orders were considered to meet the practice standards. 57.2% were inappropriate, 11.3% could not be evaluated. The number of inappropriate orders resulted in 97,953 hours of excess telemetry. Using a value of $53.44 per day as the cost of inpatient cardiac monitoring (as determined previously in the literature), this leads to a waste of $218,108.68 in June 2021.
Decreasing inappropriate telemetry usage is an opportunity for major cost savings for this health system.
