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Special Communication
Less Is More
July 2018

Eliminating Inappropriate Telemetry Monitoring: An Evidence-Based Implementation Guide

Author Affiliations
  • 1Department of Internal Medicine, Michigan Medicine, Ann Arbor
  • 2Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 3Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor
  • 4Department of Medicine, New York–Presbyterian Hospital/Weill Cornell Medical Center, New York
  • 5Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
  • 6Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 7Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 8Department of Internal Medicine, University of California, Riverside
JAMA Intern Med. 2018;178(7):971-978. doi:10.1001/jamainternmed.2018.2409
Key Points

Question  What are the most effective interventions to reduce inappropriate telemetry use?

Findings  Interventions that successfully reduced inappropriate telemetry use incorporated stakeholder education and workflow adjustments to promote routine multidisciplinary reassessment of indication and benefit of continued monitoring.

Meaning  Successful implementation of these interventions can mitigate “false alarms,” reduce unnecessary downstream testing, and improve value without sacrificing patient safety outcomes.

Abstract

In-hospital continuous electrocardiographic monitoring, commonly referred to as telemetry, has allowed for rapid recognition of life-threatening conditions, including complex arrhythmias and myocardial ischemia. However, inappropriate use can lead to unnecessary downstream testing from “false alarms,” which in turn affects clinician efficiency and increases health care costs without benefiting patients. For these reasons, the Society of Hospital Medicine’s Choosing Wisely campaign recommended use of a protocol-driven discontinuation of telemetry. The American Heart Association (AHA) developed a set of Practice Standards for the appropriate use of telemetry monitoring in 2004, which they updated in 2017. Unfortunately, the AHA Practice Standards have not been widely adopted—with as many as 43% of monitored patients lacking a recommended indication for monitoring. Thus, we created an overview discussing the safety and efficacy of incorporating the AHA Practice Standards and a review of studies highlighting their successful incorporation within patient care workflow. We conclude by outlining an “implementation blueprint” for health system professionals and administrators seeking to change their institution’s culture of telemetry use. As the health care landscape continues to shift, enacting high-value initiatives that improve patient safety and efficiency of care will be critical.

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