Overview

Physicians often use telemetry beds for patients at low risk for cardiac events who might only require infrequent nursing care. This increases facility costs through equipment purchase, maintenance and supplies, as well as nursing time and delays in patient admission and throughput, resulting from limited telemetry bed availability.1-3

The American Heart Association (AHA) has published guidelines indicating that low-risk patients do not require telemetry, as outcomes of these patients are not affected by telemetry monitoring. ([FOOTNOTE=Curry JP, Hanson CW, 3rd, Russell MW, Hanna C, Devine G, Ochroch EA. The use and effectiveness of electrocardiographic telemetry monitoring in a community hospital general care setting. Anesth Analg. 2003;97(5):1483-1487.],[ANCHOR=],[LINK=]) Studies estimate savings ranging from $250,000 to $4.8 million annually through adherence to AHA recommendations for telemetry use.2, ([FOOTNOTE=Bulger J, Nickel W, Messler J, et al. Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. J Hosp Med. 2013;8(9):486-492.],[ANCHOR=],[LINK=])

Findings like these underscore the need for hospitals to do more to reduce the use of telemetry in cases where it is not clinically indicated.

Definition

Telemetry monitoring is indicated for monitoring patients at risk for cardiac events.1 In practice, clinicians often use telemetry with the intent to provide enhanced vigilance over patients’ clinical status, even when those patients do not have a significant underlying cardiac risk.1,3

OVERUSE OF TELEMETRY CAN COST YOU

The overuse of telemetry in lower-risk patients contributes to hospital workflow bottlenecks along with increased length of stay and cost of care.2, ([FOOTNOTE=Henriques-Forsythe MN, Ivonye CC, Jamched U, Kamuguisha LK, Olejeme KA, Onwuanyi AE. Is telemetry overused? Is it as helpful as thought? Cleve Clin J Med.2009;76(6):368-372.],[ANCHOR=],[LINK=])

Overuse of telemetry is expensive and labor intensive, specifically due to the following:2

  • Equipment and supplies purchase/maintenance.
  • Mandated lower nurse-patient ratios. In California, for example, the state-mandated nurse-to patient ratio for telemetry patients is 1:4 versus 1:5 for patients in medical/surgical beds. ([FOOTNOTE=California Nurses Association/National Nurses Organizing Committee. The Ratio Solution CNA/NNOC's RN-to-Patient Ratios Work --Better Care, More Nurses. http://nurses.3cdn.net/cd91f6731ee0c22b41_uqm6yx8dy.pdf],[ANCHOR=],[LINK=])
  • Higher nursing time. One study evaluated nursing time required for patients on telemetry and reported an average 20 minutes of nursing time was spent managing the administrative, equipment, and patient care needs associated with telemetry technology. ([FOOTNOTE=Dressler R, Dryer MM, Coletti C, Mahoney D, Doorey AJ. Altering Overuse of Cardiac Telemetry in Non -Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines. JAMA Intern Med. 2014;174(11):1852-1854.],[ANCHOR=],[LINK=])
  • Delayed patient admission and throughput. In addition to the direct costs of telemetry, there are indirect costs related to emergency department (ED) backlog and hospital overcrowding. One study estimated that a delay in the ED of more than 3 hours before admission to a telemetry bed results in an opportunity cost in lost revenue of about $204 per patient. ([FOOTNOTE=Bayley MD, Schwartz JS, Shofer FS, et al. The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Ann Emerg Med. 2005;45(2):110-7.],[ANCHOR=],[LINK=])

Telemetry costs can range anywhere from $53 up to $1,400 per patient per day.2,10 Studies estimate savings ranging from $250,000 to $4.8 million annually through adherence to AHA recommendations for telemetry use.2

INCIDENCE

Telemetry is often used outside AHA consensus criteria and this use is not associated with patient benefit.1,2,4,6,([FOOTNOTE=Bulger J, Nickel W, Messler J, et al. Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. J Hosp Med. 2013;8(9):486-492.],[ANCHOR=],[LINK=]) Studies report nonindicated monitoring may account for ~35% of patient telemetry days.2,6 Several studies of nonindicated telemetry use have reported a low incidence of arrhythmias (e.g. 3.1 per 100 days of monitoring per nonindicated day) and the arrhythmias detected were clinically insignificant.4,6

One study reported 37% of patients admitted from the emergency room to a telemetry unit had nonindicated atypical chest pain and normal ECG findings. Arrhythmias were observed in only 8% of that subgroup and only four patients had events that led to an intervention. ([FOOTNOTE=Snider, A, Papaleo M, Beldner S, Park C, Katechis D, Galinkin D, Fein A. Is telemetry monitoring necessary in low-risk suspected acute chest pain syndromes? Chest.2002;122:517-523.],[ANCHOR=],[LINK=])

The AHA has published guidelines indicating that low-risk patients do not require telemetry, as outcomes of these patients are not affected by telemetry monitoring.4 Despite these recommendations and the associated evidence, three of the top diagnoses of patients admitted to telemetry units are not clinically indicated, per AHA guidelines (Table 1).1

View Table 1. Common Diagnoses of Telemetry Unit Admissions

GUIDELINES

A good first step toward avoiding telemetry overuse is to understand the AHA guidance on the topic. The AHA has published guidelines indicating that low-risk patients do not require telemetry, as outcomes of these patients are not affected by telemetry monitoring.4

To review the AHA Scientific Statement on the subject, see the article "Practice Standards for Electrocardiographic Monitoring in Hospital Settings." ([FOOTNOTE= Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation.2004;110(17):2721-2746.],[ANCHOR=],[LINK=])

VITAL SYNC™ MONITORING AND CLINICAL DECISION SUPPORT (CDS) SOLUTION

Remote monitoring and wearable patient monitoring technology may provide a cost-effective alternative for cases in which physiologic monitoring is desired but the patient does not meet the AHA criteria for cardiac telemetry.