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

• Published in: Internal medicine journal 2017-07, Vol.47 (7), p.754-760
• Main Authors: Ramkumar, Satish, Tsoi, Edward H., Raghunath, Ajay, Dias, Floyd F., Li Wai Suen, Christopher, Tsoi, Andrew H., Mansfield, Darren R.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; arrhythmia; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Clinical outcomes; Data processing; Demography; Female; guidelines; Heart; Heart diseases; Humans; inpatient; Male; Middle Aged; Patients; Practice Guidelines as Topic - standards; Prospective Studies; Telemetry; Telemetry - standards; Telemetry - trends; Tertiary Care Centers - standards; Tertiary Care Centers - trends
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.13452

Background Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs. Aim To evaluate the outcomes of guideline‐based application of cardiac telemetry. Methods Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward‐based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II – baseline) was completed prior to a 3‐month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration. Results In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean ± standard deviation (SD) age 73 years ± 14.9, 57% male), whilst 65 patients were included in the intervention (mean ± SD age 71 years ± 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post‐intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 ± 1.8 vs 2.4 ± 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05). Conclusion Guideline‐based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.