Communication Strategies and Timeliness of Response to Life Critical Telemetry Alarms

Abstract

Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bidirectional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. Methods: A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. Results: The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5 min, compared to 1.6 min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Conclusions: Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.

Differences in Alarm Events Between Disposable and Reusable Electrocardiography Lead Wires

“…Further, when an alarm sounded, it took between 3 and 5 minutes to communicate telemetry alarm events to caregivers. 7 Nursing time is expensive, and fewer false alarms could decrease costs of nursing care. When nonnursing staff (eg, remote monitoring personnel) are first responders, 2 people are automatically involved in alarm adjudication, increasing time and costs.…”

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

“…Use of a voice badge significantly short ened the time to first contact, time to completion, and rate of closedloop communication, resulting in more timely bedside care. 433 The number of waveforms a monitor watcher can effectively and safely observe is not known, although a recent study used simulation to compare response time of monitor watchers to VF over 5 different pa tient loads (16,24,32,40, and 48 patients). As patient loads increased, response times increased significantly.…”

Patient Load Effects on Response Time to Critical Arrhythmias in Cardiac Telemetry

“…There are no standards or guidelines regarding the optimal watcherto-patient ratio; thus, the patient load varies among hospitals, and watchers may monitor as many as 72 patients at a time (4)(5)(6). Decisions regarding the appropriate number of patients that a single watcher may safely and effectively monitor are largely driven by financial considerations, available technologies, and system constraints and not by our understanding of human information processing limitations.…”