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Invited Commentary
Less Is More
July 2018

Continuing to Improve Appropriateness of Continuous Electrocardiographic Monitoring (Telemetry)

Author Affiliations
  • 1Veterans Affairs Connecticut Healthcare System, West Haven
JAMA Intern Med. 2018;178(7):978-979. doi:10.1001/jamainternmed.2018.2400

Continuous electrocardiographic monitoring (telemetry) is widely used in hospitalized adult patients for many reasons. Clinicians presume that closely monitoring a patient’s heart rate, rhythm, ST-segment, and QT-interval could lead to overall benefit through multiple possible mechanisms. Detecting arrhythmias that may reflect severe clinical deterioration, such as ventricular tachycardia or high-grade atrioventricular block, could lead to stabilizing interventions. Ischemia identified through ST-segment changes could help avert infarction. QT prolongation could be corrected before leading to life-threatening arrhythmias, such as torsades de pointes. More commonly, the absence of abnormalities on telemetry could guide treatment decisions by excluding possible arrhythmic causes of patient symptoms. Finally, the sense that patients are receiving close vital sign monitoring may drive the decision to use telemetry.

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