Physician awareness of patient cardiac telemetry monitoring

Sharma, Poonam; Tesson, Alan; Wachter, Adam; Thomas, Samantha; Bae, Jonathan

doi:10.5430/jha.v5n3p76

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…Guidelines for in-hospital cardiac monitoring have been published by the American College of Cardiology [ 11 ]. However, cardiac telemetry continues to be overused due to non-adherence to the guidelines by physicians or due to unawareness of telemetry continuation days [ 6 - 7 , 10 ]. The number of days on telemetry is a clear component in the increment of hospital expenses.…”

Section: Discussionmentioning

confidence: 99%

“…As of 2009, a day’s cost of telemetric monitoring was at least $1,400 per patient. In some cases, patients are kept on telemetry longer than indicated because providers are unaware of its ongoing use [ 6 - 7 ]. Several strategies have been studied to reduce the overuse of cardiac telemetry [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In some cases, patients are kept on telemetry longer than indicated because providers are unaware of its ongoing use [ 6 - 7 ]. Several strategies have been studied to reduce the overuse of cardiac telemetry [ 6 , 8 ]. While there is a lack of consensus on the most effective method to improve the overutilization of cardiac telemetry [ 9 ], we developed a continuous quality improvement strategy and investigated the effect of reminder pop-ups, in an electronic medical record (EMR) system, on the duration and utilization of cardiac telemetry.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System

Rizvi¹,

Munguti²,

Mehta³

et al. 2017

Cureus

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Non-invasive cardiac monitoring has well-established indications and protocols. Telemetry is often overused leading to a shortage of tele-beds and an increment of hospital expenses. In some cases, patients are kept on telemetry longer than the indicated length because providers are unaware of its ongoing use. We investigated the effect of reminder pop-ups, incorporated into an electronic medical record (EMR), on minimizing the use of telemetry. Three regional hospitals implemented an electronic pop-up reminder for discontinuing the use of telemetry when no longer indicated. A retrospective analysis of data for patients on telemetry, outside of the intensive care unit (ICU), was conducted and comparisons were drawn from pre- and post-implementation periods. A composite analysis of the number of days on telemetry was calculated using the Kruskal-Wallis test. With the implementation of the pop-up reminder, the median number of days on telemetry was significantly lower in 2016 than in 2015 (2.25 vs 3.61 days, p < 0.0001). Overutilization of telemetry is widely recognized, despite not being warranted in non-ICU hospitalizations. The implementation of a pop-up reminder built into the electronic medical record system reduced the overuse of telemetry by 37% between the two time periods studied.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System

Rizvi¹,

Munguti²,

Mehta³

et al. 2017

Cureus

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“…A 2016 study by Sharma et al found that 47% of patients reviewed were monitored on telemetry. Of these patients, providers were only aware they were being monitored 74% of the time and only 58% of providers were able to provide guideline-appropriate indications for monitoring [7]. In an attempt to curb inappropriate utilization, the American Heart Association (AHA) and American College of Cardiology (ACC) updated their recommendations for continuous telemetry monitoring in 2017 [8].…”

Section: Introductionmentioning

confidence: 99%

Decreasing Inappropriate Telemetry Use via Nursing-Driven Checklist and Electronic Health Record Order Set

Knees¹,

Mastalerz²,

Berry³

2022

Cureus

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Introduction: Telemetry is ubiquitous in many hospitals despite widely acknowledged limitations, waste, and potential harm associated with inappropriate use. To curb overuse, guidelines such as the 2017 American Heart Association/American College of Cardiology (AHA/ACC) continuous telemetry monitoring practice standards have outlined appropriate telemetry use standards. This study aimed to perform two "plan-do-study-act" (PDSA) cycles and assess whether a nursing (RN)-driven checklist addressing appropriate telemetry use, combined with just-in-time education delivered via an electronic health record (EHR) order set modification, was efficacious in reducing inappropriate telemetry use within a level 1a Veterans Health Administration hospital.Methods: This is a quality improvement intervention study that took place between March 2019 and August 2020. Three cohorts were sequentially studied: a control cohort without any intervention (n = 100), a cohort with only the RN-driven checklist (n = 100), and a cohort with both the RN-driven checklist and an EHR order set modification that provided just-in-time education about telemetry indications (n = 100). Telemetry records were reviewed by a physician to determine indication, duration for each telemetry order, and appropriateness. An order was deemed "appropriate" if it met AHA/ACC classification grade I (telemetry recommended) or IIa/b (telemetry may be considered) and "inappropriate" if it fell under class III (telemetry not recommended). Data were compared between the control cohort and the two intervention cohorts, as well as between intervention cohorts, using Pearson chi-square analysis. A p-value < 0.05 was considered statistically significant.Results: Within the control group, 37% of telemetry orders were deemed inappropriate. After implementation of the RN checklist, a non-statistically significant lower proportion (26%) of orders was deemed inappropriate (p = 0.09). Implementation of the RN checklist, along with the EHR order set, was associated with a significantly lower proportion of inappropriate orders (17%) in comparison to the control cohort (p = 0.001) but not in comparison to the RN checklist cohort (p = 0.12). There was no significant difference in the duration of telemetry use across cohorts.Conclusions: An RN-driven checklist and EHR telemetry order set modification were associated with a decrease in inappropriate telemetry use from 37% to 17%. By prompting the review of telemetry orders via a daily nursing checklist reviewed during bedside interdisciplinary rounds, clinicians received reinforcement regarding appropriate telemetry indications. This education was strengthened by the just-in-time training provided via the EHR order set.

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Decreasing unnecessary use of continuous cardiac monitoring (telemetry) in hospitalised patients

Silverstein,

Chang,

Sreenivasan

et al. 2024

BMJ

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Physician awareness of patient cardiac telemetry monitoring

Cited by 3 publications

References 9 publications

Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System

Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System

Decreasing Inappropriate Telemetry Use via Nursing-Driven Checklist and Electronic Health Record Order Set

Decreasing unnecessary use of continuous cardiac monitoring (telemetry) in hospitalised patients

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