ABSTRACT

Telemetry Use in a Peripheral Hospital Setting

Aim: ​To determine if telemetry monitoring requests were appropriate and whether further monitoring devices were required to cope with demand.

Methods: ​This audit is a retrospective study undertaken at Whangarei Hospital, where a consecutive sampling of 50 cases of patients requiring inpatient telemetry monitoring were reviewed. A separate subanalysis was carried out to quantify the average duration of telemetry monitoring per patient, where a further 100 cases were prospectively recruited. Each case was reviewed for indication for referral, type of monitoring requested and whether they have a completed referral form in the medical records. The data collected was compared to the AHA Scientific Statement of Practice Standards for Electrocardiographic Monitoring in Hospital Settings, published in 2004 and the American Stroke Association Guidelines for the Early Management of Patients With Acute Ischemic Stroke, published in 2013.

Results: The average age of patients on telemetry was 71.4 years. The gender ratio of the audit population was 31 males (62%) and 19 females (38%). 42/50 (84%) patients on telemetry monitoring were referred by the medical department and 8/50 (16%) patients were referred by the surgical, anaesthetics or orthopaedics department. 48/50 (96%) of the request forms were filed in the medical records upon discharge. 2 forms requested for patients in the orthopaedics ward were not available in the medical records for review, therefore these have been excluded from analysis. 43/48 (90%) of patients receiving telemetry have the type of monitoring required indicated on telemetry request form. The most common reasons for requesting telemetry were chest pain, 14/48 (29%) and arrhythmia, 13/48 (27%). Other indications were collapse, stroke/TIA, overdose or electrolyte disturbances. The average length of telemetry duration was 28 hours and 28 minutes. 30/48 (63%) of the referral diagnoses fell into Class I level of evidence, showing that cardiac monitoring is indicated in most, if not all, of the patients in this group. 15/48 (31%) of the referrals fell into Class II level of evidence, where cardiac monitoring may be of benefit in some patients but not necessarily essential. 3/48 (6%) fell into Class III level of evidence which shows that telemetry use in these cases have no therapeutic benefit.

Conclusions: The audit shows that 94% of the telemetry requests at Whangarei Hospital are appropriate according to international guidelines. We did not feel that the duration of telemetry monitoring was excessive. Given the difficulty in accessing telemetry faced by clinical staff, consideration should be given to increasing the number of telemetry units and making sure they are adequately monitored..