Tell‐a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system

Abstract

Background: Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing.Methods: This quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA) that would fire after the recommended time period for reassessment had passed. Results:The average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-h reorder rate.There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner). Conclusion:We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.

Evaluation of a Clinical Decision Support Tool to Guide Adoption of the American Heart Association Telemetry Monitoring Practice Standards

“… 25 Similarly, a study that also implemented a ordering CDS and monitoring duration alert demonstrated a roughly 20% decrease in telemetry monitoring hours per patient encounter. 27 This study adds to the literature because it describes physician behavior, as well as highlights and describes some of the contextual factors for why some implementation strategies may be more effective than others. For example, the qualitative portion of this study demonstrated that when a physician is required to provide an indication for telemetry monitoring, this causes them to reflect and consider if telemetry monitoring is really warranted, thereby decreasing potentially unnecessary telemetry monitoring use.…”

Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11‐hospital safety net system: An electronic health records‐based approach

“…21 However, our recent published successes in reducing overuse in our system shed some insights into implementation. 18,[22][23][24][25] In particular, EHR-based interventions, if developed well and tailored through expert stakeholder input, can bring forth a low-effort, highimpact change suited for large, resource-limited settings. An important concept is that order sets are effective only so much as clinicians use them.…”