Guideline-based intervention to reduce inappropriate telemetry use in a large tertiary centre

Satish Ramkumar¹, Edward H. Tsoi¹, Ajay Raghunath², Floyd F. Dias², Christopher Li Wai Suen¹, Andrew H. Tsoi², Darren R. Mansfield¹

1) Department of General Medicine, Dandenong Hospital, Monash Health, Victoria, Australia                                              2) School of Medicine, Monash University, Victoria, Australia

Background: Inappropriate telemetry use is associated with reduced patient flow and increased health care costs.

Aims: To assess if guideline based telemetry admissions and a daily telemetry ward round is associated with a reduction in inappropriate telemetry use.

Methods: A prospective intervention study which included patients requiring ward based telemetry (under the general medical unit). Patients were studied in a three-month period preceding intervention(Feb-April 2015) and in a consecutive three-month period following intervention(May-July 2015). Exclusion criteria included intensive care or coronary care admission and specialty medicine/surgical patients. The intervention consisted of an admission form which categorised patients based on the American Heart Association guidelines: telemetry is indicated(class I), maybe indicated(class II) and not indicated(class III). The second intervention included a daily telemetry ward round. Telemetry data and medical records were used to obtain patient demographics as well as identifying clinical outcomes. The primary endpoint was the number of patients admitted with a class III indication (telemetry not indicated). Secondary endpoints included length of stay and duration of telemetry.

Results: 74 patients were included pre-intervention (mean±SD age 73 yrs ±14.9, 57% male) whilst 65 patients were included post-intervention (mean±SD age 71 yrs ±18.4, 35% male). Apart from more male patients pre-intervention, both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention (11% vs. 38%, p<0.001) and an increase in class II admissions (71% vs 49%, p=0.01). The intervention was associated with a reduction in median telemetry duration (1.8±1.8 vs 2.4±2.5 days, p=0.047) however median length of stay was similar in both groups (5.0±5.0 vs 5.0±6.0 days, p=0.76).

Conclusion: Guideline based telemetry admissions and a regular telemetry ward round is associated with a reduction in inappropriate telemetry use and possibly a reduction in telemetry duration. This may result in improved patient flow and reduced health care costs.