Use and Outcomes of Telemetry Monitoring on a Medicine Service

Telemetry Monitoring: Are Admission Criteria Based on Evidence?

“…In most of the studies 2,5,7,9,11 in this review, researchers reported that patients who had telemetry ordered did not meet class I and class II indications. Furthermore, arrhythmic events were infrequent and clinically insignificant.…”

“…Table 4 shows common diagnoses used in ordering telemetry. These results suggest that the practice standards do not address several noncardiac conditions that physicians often monitor on telemetry units 5,6,8 and thus may not apply to patients with primary medical diagnoses. 5 For example, in a randomized controlled trial by Funk et al, 9 28.2% of patients admitted to cardiac units from 17 hospitals had a noncardiac primary diagnosis; these patients may not be appropriate for monitoring for arrhythmia, ischemia, and increased QT interval.…”

“…These results suggest that the practice standards do not address several noncardiac conditions that physicians often monitor on telemetry units 5,6,8 and thus may not apply to patients with primary medical diagnoses. 5 For example, in a randomized controlled trial by Funk et al, 9 28.2% of patients admitted to cardiac units from 17 hospitals had a noncardiac primary diagnosis; these patients may not be appropriate for monitoring for arrhythmia, ischemia, and increased QT interval. Of the 7 diagnoses common to both hospital admission via the emergency department and telemetry unit admission, pulmonary disease and respiratory distress (ie, chronic obstructive pulmonary disease or pneumonia) 11,13 are 2 conditions without indications for ECG monitoring per AHA practice standards.…”

“…Yet, patients are still admitted to telemetry units for these conditions. 5,6 Causes for overmonitoring and undermonitoring may be lack of awareness and/or nonadherence to practice standards by clinicians, or a combination of other factors such as technology, equipment, and condition-specific Fewer than 1/3 telemetry days (in a 3-week period) did not meet American Heart Association (AHA) indications Arrhythmia incidence on nonindicated days low (3.1/100 days of monitoring per nonindicated day); detected arrhythmias were clinically insignificant Eliminating nonindicated days could save $53/patient day 29% admissions never met indications on any day; only 17% met on any day 95% events (n = 162) occurred on 400 tele-indicated days; 5% occurred on 345 non-tele-indicated days (n = 9 minor events required no therapy)…”

“…The Figure outlines the databases, key search terms, and relevant articles matching the inclusion and exclusion criteria. The final evidence matrix included 1 expert consensus statement, 8 3 retrospective studies, 2,7,11 2 prospective observational studies 5,10 and 1 randomized clinical trial 9 (Tables 2 and 3). …”