Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health Record Change and a Multifaceted Hospitalist Intervention

Edholm, Karli; Kukhareva, Polina; Ciarkowski, Claire; Carr, Jason; Gill, David; Rupp, Austin B.; Morshedzadeh, Jack H.; Wanner, Nathan; Kawamoto, Kensaku

doi:10.12788/jhm.2933

Cited by 12 publications

(20 citation statements)

References 15 publications

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“…One of these reduced laboratory costs by 16%, while the other reduced daily charges for telemetry monitoring in an academic medical center by 69%. 45,46 A third study, by Schwartz and coauthors, examined myriad low-value services and found overall reductions in low-value services among organizations participating in the Medicare accountable care organization program, though heterogeneity in reductions in individual types of services. For example, while low-value cancer testing dropped by 2.4% relative to the mean, preoperative services experienced no statistically significant change in use.…”

Section: Clinician-focused Intervention Componentsmentioning

confidence: 99%

The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review

Cliff¹,

Avanceña

Hirth

et al. 2021

Milbank Quarterly

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r Dissemination of Choosing Wisely guidelines alone is unlikely to reduce the use of low-value health services. r Interventions by health systems to implement Choosing Wisely guidelines can reduce the use of low-value services. r Multicomponent interventions targeting clinicians are currently the most effective types of interventions. Context: Choosing Wisely aims to reduce the use of unnecessary, low-value medical services through development of recommendations related to service utilization. Despite the creation and dissemination of these recommendations, evidence shows low-value services are still prevalent. This paper synthesizes literature on interventions designed to reduce medical care identified as low value by Choosing Wisely and evaluates which intervention characteristics are most effective. Methods: We searched peer-reviewed and gray literature from the inception of Choosing Wisely in 2012 through June 2019 to identify interventions in the United States motivated by or using Choosing Wisely recommendations.We also included studies measuring the impact of Choosing Wisely on its own, without interventions. We developed a coding guide and established coding agreement. We coded all included articles for types of services targeted, components of each intervention, results of the intervention, study type, and, where

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Section: Clinician-focused Intervention Componentsmentioning

confidence: 99%

The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review

Cliff¹,

Avanceña

Hirth

et al. 2021

Milbank Quarterly

View full text Add to dashboard Cite

show abstract

“…Highly reliable, precise, user-friendly, and cost-effective clinical alarm systems are critical to efficient functioning of health-care facilities [1][2][3]. Despite tremendous progress over the past few decades, the "perfect solution" remains elusive, with focus being placed primarily on clinical indications and appropriateness of use for the existing equipment and monitoring frameworks [3][4][5][6]. Beyond the concept of "false alarm," suboptimal implementation of clinical monitoring systems can have much more profound and potentially dangerous consequences [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Nguyen¹,

Davis²,

Guglielmello³

et al. 2019

Vignettes in Patient Safety - Volume 4 [Working Title]

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As the demand for health-care services continues to increase, clinically efficient and cost-effective patient monitoring takes on a critically important role. Key considerations inherent to this area of concern include patient safety, reliability, ease of use, and cost containment. Unfortunately, even the most modern patient monitoring systems carry significant drawbacks that limit their effectiveness and/or applicability. Major opportunities for improvement in both equipment design and monitor utilization have been identified, including the presence of excessive false and nuisance alarms. When poorly optimized, clinical alarm activity can affect patient safety and may have a negative impact on care providers, leading to inappropriate alarm response time due to the so-called alarm fatigue (AF). Ultimately, consequences of AF include missed alerts of clinical significance, with substantial risk for patient harm and potentially fatal outcomes. Targeted quality improvement initiatives and staff training, as well as the proactive incorporation of technological improvements, are the best approaches to address key barriers to the optimal utilization of clinical alarms, AF reduction, better patient care, and improved provider job satisfaction.

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“…14 Other studies have shown that multicomponent interventions including education, process change, routine feedback, and financial incentives decrease telemetry utilization. 7 As in the Najafi et al study, our intervention was not significantly resource-intensive and only involved modifications to the EHR. Directly engaging the primary provider for the patient to consider discontinuation of telemetry orders also supported active-provider decision-making for patients whose telemetry order exceeded the standard duration for a specific indication.…”

Section: Discussionmentioning

confidence: 99%

“…6 Several studies have tried different approaches to address these shortcomings including provider education, routine feedback, provider incentives, and modifications to electronic health record (EHR) telemetry orders. These studies have demonstrated that multifaceted approaches do in fact lead to more appropriate telemetry utilization and duration of use, [7][8][9][10] but may require more resources and time to complete. Other studies have shown that changes to the EHR with reminders about discontinuing telemetry via pop-up dialog boxes or automatic telemetry discontinuation after a set time period, without provider education or incentives, were enough to encourage appropriate telemetry ordering and increase timely telemetry discontinuation.…”

Section: Background and Significancementioning

confidence: 99%

Harnessing the Electronic Health Record to Actively Support Providers with Guideline-Directed Telemetry Use

et al. 2021

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Background Overuse of cardiac telemetry monitoring (telemetry) can lead to alarm fatigue, discomfort for patients, and unnecessary medical costs. Currently there are evidence-based recommendations describing appropriate telemetry use, but many providers are unaware of these guidelines. Objectives At our multihospital health system, our goal was to support providers in ordering telemetry on acute care in accordance with evidence-based guidelines and discontinuing telemetry when it was no longer medically indicated. Methods We implemented a multipronged electronic health record (EHR) intervention at two academic medical centers, including: (1) an order set requiring providers to choose an indication for telemetry with a recommended duration based on American Heart Association guidelines; (2) an EHR-generated reminder page to the primary provider recommending telemetry discontinuation once the guideline-recommended duration for telemetry is exceeded; and (3) documentation of telemetry interpretation by telemetry technicians in the notes section of the EHR. To determine the impact of the intervention, we compared number of telemetry orders actively discontinued prior to discharge and telemetry duration 1 year pre- to 1 year post-intervention on acute care medicine services. We evaluated sustainability at years 2 and 3. Results Implementation of the EHR initiative resulted in a statistically significant increase in active discontinuation of telemetry orders prior to discharge: 15% (63.4–78.7%) at one site and 13% at the other (64.1–77.4%) with greater improvements on resident teams. Fewer acute care medicine telemetry orders were placed on medicine services across the system (1,503–1,305) despite an increase in admissions and the average duration of telemetry decreased at both sites (62 to 47 hours, p < 0.001 and 73 to 60, p < 0.001, respectively). Improvements were sustained 2 and 3 years after intervention. Conclusion Our study showed that a low-cost, multipart, EHR-based intervention with active provider engagement and no additional education can decrease telemetry usage on acute care medicine services.

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Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health Record Change and a Multifaceted Hospitalist Intervention

Abstract: Although electronic telemetry ordering changes can produce decreases in hospital-wide telemetry monitoring, a multifaceted intervention may lead to an even larger decline in utilization rates. Whether these changes are durable cannot be ascertained from our study.

Cited by 12 publications

References 15 publications

The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review

The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Harnessing the Electronic Health Record to Actively Support Providers with Guideline-Directed Telemetry Use

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