Evaluation of guidelines for the use of telemetry in the non-intensive-care setting

Abstract

To determine if the American College of Cardiology (ACC) cardiac monitoring guidelines accurately stratify patients according to their risks for developing clinically significant arrhythmias in non-intensive-care settings, we conducted a prospective cohort study of 2,240 consecutive patients admitted to a non-intensive-care telemetry unit over 7 months. Sixty-one percent of patients were assigned to ACC class I (telemetry indicated in most patients), 38% to class II (telemetry indicated in some), and 1% to class III (telemetry not indicated). Arrhythmias were detected in 13.5% of the class I patients, 40.7% of the class II patients, and 12% of the class III patients ( p Ͻ .001). Telemetry detected an arrhythmia resulting in transfer to an intensive care unit in 0.4% of the class I patients, 1.6% of the class II patients, and none of the class III patients ( p ϭ .006). Telemetry led to a change in management for 3.4% of the class I patients, 12.7% of the class II patients, and 4% of the class III patients ( p Ͻ .001). When patients with chest pain as the reason for admission were moved from class I to class II and patients with arrhythmias as the reason for admission were moved from class II to class I, more arrhythmias and more clinically significant arrhythmias occurred in class I patients and the trends from class I to class III were more consistent with the purpose of the guidelines. These findings indicate that when the ACC guidelines are reexamined, consideration should be given to changing them so they are more useful in non-intensive-care settings.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…These rates of change in care management were higher than the 7% to 8% reported in other studies. 491, 494 Fålun et al 58 recommended revision of the 2004 practice standards 1 on the basis of their finding that nearly half of COR III patients experienced arrhythmia events and one third of these events resulted in changes in care management. This may be related in part to the clas sification of patients with syncope in COR III per 2004 standards.…”

Use and Outcomes of Telemetry Monitoring on a Medicine Service

“…3 In the largest study of telemetry to date, only 121 of 2240 patients (5%) who underwent telemetry were admitted with noncardiac diagnoses. 4 Weperformed a study to better characterize the reasons why patients on a medicine service are placed on telemetry monitoring as well as the frequency of clinically significant telemetry events.…”

Organizational Approaches to Improving Resuscitation Effectiveness

“…Indeed, standard guidelines for the use of telemetry may overestimate risk in some patients and underestimate it in others, leading to false alarms in the former and missed arrhythmias in the latter. 16 Early detection models can help identify at-risk patients who may benefit from closer monitoring, either in situ or by a move to a higher level of care.…”