Are the American College of Cardiology/Emergency Cardiac Care (ACC/ECC) guidelines useful in triaging patients to telemetry units?

Tiongson, Jay; Robin, Jason; Chana, Amar; Shin, David; Gheorghiade, Mihai

doi:10.1080/17482940600934192

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…2,5,8 These studies have taken place in single hospitals using guidelines from 19912,5 or hospital-specific protocols 8. The PULSE Trial is being conducted at 17 hospitals using more recent standards6 that also incorporate recommendations for ischemia and QT interval monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use of the Latest Standards for Electrocardiography trial

Funk

Winkler

May

et al. 2010

Journal of Electrocardiology

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Purpose-To examine the appropriate use of arrhythmia, ischemia, and QTc interval monitoring in the acute care setting.Methods-We analyzed baseline data of the PULSE Trial, a multi-site randomized clinical trial evaluating the effect of implementing ECG monitoring practice standards. Research nurses reviewed medical records for indications for monitoring and observed if arrhythmia, ischemia, and QT interval monitoring were being done on 1,816 patients in 17 hospitals.Results-Almost all (99%) patients with an indication for arrhythmia monitoring were being monitored, but 85% of patients with no indication were monitored. Of patients with an indication for ischemia monitoring, 35% were being monitored, but 26% with no indication were being monitored Corresponding Author: Marjorie Funk, PhD, RN, Professor, Yale University School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536-0740, Telephone: 203-737-2346, marjorie.funk@yale.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access MethodsThe PULSE Trial is a 5-year (2008-2013) multi-site randomized clinical trial to evaluate the implementation of the AHA Practice Standards for ECG Monitoring 6 on nurses' knowledge, quality of care including the appropriateness of monitoring, and patient outcomes. The intervention consists of an online ECG monitoring education program and strategies to implement and sustain change in practice, led by nurse champions on each unit. The study takes place in 17 hospitals: 15 in the United States, 1 in Ottawa, Canada, and 1 in Hong Kong, China (Table 1). All hospitals received institutional review board approval. Sites include both academic medical centers and community hospitals. Hospital units involved in the study are primarily for the treatment of cardiac surgical and medical patients. They include both intensive care units (ICUs) with "hard-wire" bedside cardiac monitoring and step-down units with "wireless" telemetry monitoring.For the baseline quality of care data, our sample consisted of 2,744 observations on 1,816 patients on these adult cardiac units. One of three research nurses, who were experienced ICU nurses with expertise in ECG monitoring, visited each site for 5 days. If time permitted, they observed patients more than once during their 5-day visit. They collected data on the use and appropriateness of monitoring by reviewing the current medical records to determine if the patient had a Class I or II indication for arrhythmia, ischemia, or QT interval monitoring. The AHA Practice Standards 6 used the following rating system for indicati...

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Section: Discussionmentioning

confidence: 99%

“…Although electrocardiographic (ECG) monitoring is the cornerstone of care in hospital cardiac units, few studies1–5 have evaluated how it is used. The American Heart Association (AHA) Practice Standards for ECG Monitoring in Hospital Settings6 specify indications and time frames for ECG monitoring.…”

mentioning

confidence: 99%

Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use of the Latest Standards for Electrocardiography trial

Funk

Winkler

May

et al. 2010

Journal of Electrocardiology

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“…The number of published evaluations of the original 1991 ACC/Emergency Cardiac Care Committee 489 and AHA 1 electrocardiographic monitoring standards has increased and has included QI projects, 490 intervention al research of electrocardiographic monitoring guide lines, [56][57][58][59]449,491 and more recently, an RCT. 6 These stud ies have addressed electrocardiographic monitoring for chest pain, association of practice standards with pa tient outcomes, practice standard use, and outcomes evaluated in studies of electrocardiographic monitor ing.…”

Section: Findings From Past Studies Of Electrocardiographic Monitoringmentioning

confidence: 99%

“…These rates of change in care management were higher than the 7% to 8% reported in other studies. 491, 494 Fålun et al 58 recommended revision of the 2004 practice standards 1 on the basis of their finding that nearly half of COR III patients experienced arrhythmia events and one third of these events resulted in changes in care management. This may be related in part to the clas sification of patients with syncope in COR III per 2004 standards.…”

Section: Electrocardiographic Monitoring For Chest Painmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

201

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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“…1 One such protocol was revised twice by the American Heart Association (AHA) in 2004 and 2017 and has been found to predict cardiac events and change patient management. [2][3][4] No prior studies have assessed the decision-making process physicians use regarding telemetry. This study aims to assess that decision-making process in relationship to the AHA practice standards, thus having the potential to inform implementation of ABIM's recommendation.…”

Section: Introductionmentioning

confidence: 99%

Choosing Telemetry Wisely: a Survey of Awareness and Physician Decision-Making Regarding AHA Telemetry Practice Standards

et al. 2018

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Are the American College of Cardiology/Emergency Cardiac Care (ACC/ECC) guidelines useful in triaging patients to telemetry units?

Cited by 8 publications

References 25 publications

Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use of the Latest Standards for Electrocardiography trial

Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use of the Latest Standards for Electrocardiography trial

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Choosing Telemetry Wisely: a Survey of Awareness and Physician Decision-Making Regarding AHA Telemetry Practice Standards

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