Guideline‐based intervention to reduce telemetry rates in a large tertiary centre

Abstract

Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.

Audit‐based measures of overuse of medical care in Australian hospital practice

“…For studies of investigations (Table ), rates of overuse (and number of corresponding studies in parentheses) comprised: 64% of coagulation tests in patients with various clinical presentations ( n = 1) 22% of thrombophilia screening tests in patients with venous thromboembolism ( n = 1) 34–62% of computed tomography scans of pulmonary arteries in suspected pulmonary thromboembolism ( n = 4) 36–40% of imaging tests in patients with low back pain ( n = 2) 54% of imaging tests in patients with abdominal pain ( n = 1) 63% of blood cultures in patients with suspected sepsis ( n = 1) 23–43% of troponin assays in patients with chest pain ( n = 2) 20% of echocardiographs in patients with various cardiac conditions ( n = 1) 17% of myocardial perfusion scans in patients with stable angina ( n = 1) 38% of referrals for telemetry monitoring in patients at risk of arrythmia 10% of liver biopsies in patients with various types of liver disease ( n = 1) …”

“…Of the eight studies reporting post‐audit use of QI strategies, professional education strategies, guideline or pathway dissemination, and implementation of algorithms and other forms of decision support were the dominant strategies used. Of the five studies reporting results of post‐QI follow‐up audits, all relating to use of investigations, absolute reductions in rate of overuse of between 12 and 35 percentage points were achieved.…”

“…• 14-74% of blood product infusions among patients with various conditions (n = 3) [21][22][23] • 15-55% of older patients receiving at least one inappropriate medication (n = 7) [24][25][26][27][28][29][30] • 34% of chronically prescribed medications of various classes among older patients (n = 1) 31 • 99% of ondansetron prescriptions in patients with severe emesis (n = 1) 32 • 63-90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units (n = 2) 33,34 • 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions (n = 1) 35 • 21% of antimicrobial prescriptions for patients with acute infections (n = 1) 36 • 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease (n = 1) 37 • 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease (n = 1) 38 • 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk (n = 1) 39 • 10-64% of end-of-life care admissions featuring the administration of futile interventions (n = 3) [40][41][42] Of the eight studies reporting post-audit use of QI strategies, 7,[9][10][11]15,19,21,22 professional education strategies, guideline or pathway dissemination, and implementation of algorithms and other forms of decision support were the dominant strategies used. Of the five studies reporting results of post-QI follow-up audits, 7,9,11,15,19 all relating to use of investigations, absolute reductions in rate of overuse ...…”

Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use

“…In this context, care delivery is emphasizing the right type of care, for the right reasons, delivered in a timely fashion to the right type of medical condition. Multiple studies have documented the inappropriate use of telemetry during hospitalization [2][3][4][5][6][7]. Because the use of telemetry requires staff and equipment, its inappropriate use is associated with increased hospital costs and a longer length of stay without a demonstrable improvement in patient care or safety [6].…”

“…A number of factors have been documented to result in the inappropriate utilization of telemetry [2][3][4][5][6][7][8]. Insufficient knowledge of the American Heart Association (AHA) guidelines for telemetry, lack of optimal awareness and ownership of telemetry implementation, duration of ongoing monitoring and the timing of its discontinuation remain the most important elements [2][3][4][5][6].…”