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

Rizvi, Wajeeha; Munguti, Cyrus; Mehta, Jeet; Kallail, K. James; Youngman, Darrell; Antonios, Samer

doi:10.7759/cureus.1282

Cited by 9 publications

(11 citation statements)

References 11 publications

(16 reference statements)

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“…The intervention of introducing a hard-stop into admission orders is easily accomplished and easily measurable. Although our findings are from a single institution, other investigators have found similar results when investigating the use of prompts or ‘hardwiring’ order sets to minimise the use of telemetry not supported by the AHA guidelines 11 20…”

Section: Resultssupporting

confidence: 72%

Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project

et al. 2019

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For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care.This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years.During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.

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Section: Resultssupporting

confidence: 72%

Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project

et al. 2019

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“…In addition, the duration of telemetry fell by 47% (before implementation of AHA guidelines=57.8±2.4 (mean±SD) hours vs. after implementation of AHA guidelines=30.9±0.9 (mean±SD) hours). Similarly, Rizvi et al focused on the notification for renewal of telemetry after 48 hours and caused a significant reduction in duration of telemetry from 3.61 to 2.7 days [12]. Our approach concentrated on residents to reduce an inappropriate use of telemetry and produced clinically meaningful results cited above.…”

Section: Discussionmentioning

confidence: 93%

“…Multiple investigators have demonstrated a reduction in telemetry utilization by using various approaches [8,[11][12][13][14]. By hardwiring AHA guidelines into their electronic ordering system (EOS), Dressler et al observed a 43% reduction in weekly number of telemetry orders (before implementation of AHA guidelines=1032.3±32.1 [mean±SD] vs. after implementation of AHA guidelines=593.2±21.3 [mean±SD]) [8].…”

Section: Discussionmentioning

confidence: 99%

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

Patel¹,

Shariff²,

Shah³

et al. 2019

AJIM

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Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the intervention. The non-house-staff covered patients did not receive the intervention and served as the control group. The intervention included the implementation of American Heart Association cardiac monitoring guidelines, daily tele-census and indication evaluation, and discussion around telemetry status during multidisciplinary rounds. Data were collected from the pre-(90 day) and post intervention (90 day) periods for both groups. The intervention resulted in a 49% relative decrease in the average telemetry days in the intervention group (pre-intervention=5.7 days vs. post-intervention=2.9 days; p<0.001). The number of patients maintained on telemetry for >48 hours also decreased by 56% in the intervention group. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.

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“…Further interventions likely need to be incorporated to remind providers of the need to discontinue telemetry at the earliest appropriate opportunity as clinically indicated. A study by Rizvi et al showed that incorporating pop-ups in the electronic medical system for discontinuing telemetry reduced overuse of telemetry by 37% [8]. Such an intervention or the use of expiration dates with initial order of telemetry, which currently does not exist in our hospital, may be helpful in stopping telemetry when no longer indicated.…”

Section: Discussionmentioning

confidence: 99%

Monitoring the Use of Telemonitor: A Resident-run Quality Improvement Initiative Decreases Inappropriate Use of Telemonitor in a Community Hospital

Maduke

Qureshi

Goite

et al. 2019

Cureus

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BackgroundCardiac telemetry is an important tool to detect life-threatening conditions in hospitalized patients but is used widely and inappropriately. We sought to assess current usage and improve the appropriate use of telemetry in a community hospital.MethodsWe conducted a quality improvement project on patients who were admitted on telemetry floors between January and March 2017 (pre-intervention). The indication(s) and duration of telemonitor use, event(s) recorded on telemonitor and outcome of the event(s) were documented. A six-month educational intervention was undertaken and the effect of intervention was assessed among patients admitted between December 2017 and February 2018 (post-intervention).ResultsIn the pre-intervention group, 329 patients qualified for the study, with a median age of 78 years. The post-intervention group had 383 qualified patients with a median age of 77 years. Mean duration of telemonitor use was four days in both groups. In the pre-intervention group, 54% had class I, 32% had class II, and 14% had class III indications. In post-intervention group, 46% had class I, 42% had class II, and 12% had class III indications. The educational intervention resulted in a trend towards less inappropriate use of telemetry, particularly in teaching service. Telemonitor events were recorded in 22 (7%) of the pre-intervention patients and 13 (4%) of the post-intervention group. Two patients died in the pre-intervention group and one in the post-intervention group from non-cardiac causes.ConclusionOur results highlight that change in practice requires sustained education interventions.

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

Cited by 9 publications

References 11 publications

Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project

Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project

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

Monitoring the Use of Telemonitor: A Resident-run Quality Improvement Initiative Decreases Inappropriate Use of Telemonitor in a Community Hospital

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