TY - JOUR
T1 - Eliminating inappropriate telemetry monitoring
T2 - An evidence-based implementation guide
AU - Yeow, Raymond Y.
AU - Strohbehn, Garth W.
AU - Kagan, Calvin M.
AU - Petrilli, Christopher M.
AU - Krishnan, Jamuna K.
AU - Edholm, Karli
AU - Sussman, L. Scott
AU - Blanck, Jaime F.
AU - Popa, Remus I.
AU - Pahwa, Amit K.
PY - 2018/7
Y1 - 2018/7
N2 - In-hospital continuous electrocardiographic monitoring, commonly referred to as telemetry, has allowed for rapid recognition of life-threatening conditions, including complex arrhythmias andmyocardial 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.
AB - In-hospital continuous electrocardiographic monitoring, commonly referred to as telemetry, has allowed for rapid recognition of life-threatening conditions, including complex arrhythmias andmyocardial 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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U2 - 10.1001/jamainternmed.2018.2409
DO - 10.1001/jamainternmed.2018.2409
M3 - Article
C2 - 29868894
AN - SCOPUS:85049529149
SN - 2168-6106
VL - 178
SP - 971
EP - 978
JO - JAMA internal medicine
JF - JAMA internal medicine
IS - 7
ER -