Telemetry has become a standard tool in hospitals for monitoring patients who require continuous ECG monitoring, but evidence shows it’s widely overused. Up to 43% of hospital telemetry use occurs without indication¹, while one study showed only 24% of telemetry days were determined to be appropriate based on practice standards.²
Despite usage guidelines by the AHA and recommendations by the Society of Hospital Medicine to adopt a protocol-driven approach to continuous ECG monitoring, overutilization remains a problem.¹
One analysis found that telemetry ordered outside of AHA guidelines, had a documented benefit of less than 1%.³ Another study demonstrated that clinical care was changed for only 7% of patients on telemetry, as a result of their telemetry usage.⁴
These findings suggest that telemetry is often being used as part of a “defensive medicine” strategy, fueled by a fear of missing clinical events.⁵
Telemetry overuse creates ripple effects across healthcare systems in the form of operational strain, patient safety risks, and financial impact.
Unnecessary telemetry creates a high alarm burden for clinical teams, contributing to clinician cognitive overload.⁶ ⁷ Alarm fatigue is a well-documented challenge in clinical care environments, driven in part by the sheer volume of alerts clinicians must process. In a study of 2,029 medical-surgical nurses, 84.6% reported feeling overwhelmed by the number of clinical alarms.⁸ Over time, this constant exposure can lead to alarm fatigue, which occurs when clinicians develop decreased reactivity and begin to tune out alarms.⁹
Beyond alarm burden, unnecessary telemetry also places strain on hospital operations. Its use can diminish hospital throughput and increase a patient’s length of stay.⁴ ¹¹
While intended to protect patients, telemetry overuse can create unintended safety risks. This concern is reflected in national risk assessments, where overuse of telemetry was one of the top 10 ECRI digital health hazards in 2023.⁶
As clinicians become desensitized to frequent alarms, critical events may be missed.⁶ ⁷ The consequences of alarm fatigue vary widely, ranging from disturbed rest to missed periods of instability due to alarm desensitization.⁹
Telemetry can also disrupt patient sleep,⁵ and sleep disturbance has substantial potential impacts on patient recovery from illness and operation.¹⁰
Reducing inappropriate use of telemetry can reduce overall health care expenditure, as telemetry overutilization costs approximately $54 per patient per day.¹ ¹²
In one analysis, reducing telemetry use by an average of 1.21 to 4.22 days resulted in calculated cost savings of $22,199 per month.⁴
Other analyses highlight the scale of unnecessary use driving these costs. Nearly a quarter of patients were placed on telemetry without indication, and 56% of the remaining patients stayed on telemetry longer than recommended, resulting in more than $500,000 in annualized costs associated with inappropriate telemetry use.
Despite awareness and published guidance, telemetry can persist as part of a “defensive medicine” strategy, fueled by a fear of missing clinical events and a fear of missing clinical arrhythmias.⁵ When telemetry is used for patients who do not require it, it can lead to patients overall being less effectively monitored.
What has been missing is a scalable way to continuously monitor key vital signs for patients who do not require continuous ECG monitoring but still warrant oversight for signs of deterioration. One challenge to early recognition of patient decline is variation in the frequency of manual vital sign measurements, particularly during overnight hours.¹⁵ Because these measurements are intermittent, monitoring gaps occur, creating periods when changes in physiologic condition can go unnoticed.¹⁶ In fact, spot-checking can leave patients unmonitored 96% of the time.¹⁷
This is where technologies such as the BioButton® multi-parameter wearable device can play an important role. The BioButton® provides continuous monitoring of vital signs with high clinical accuracy.¹⁸ It has demonstrated the ability to generate timely notifications for physiologic abnormalities, such as elevated heart rate or respiratory rate, which can precede clinical deterioration events by several hours and may allow for earlier intervention.¹⁸
In addition, BioButton® detects the majority of events with a minimal frequency of alarms.¹⁸ Notifications generated by the BioButton® system have led to actionable changes in patient care, including new diagnoses and adjustments in treatment, demonstrating a measurable impact on clinical management.¹⁸
Telemetry plays a critical role in patient monitoring when used appropriately. However, when applied too broadly, telemetry overuse can create unintended consequences, including clinician cognitive overload and missed critical events, a high alarm burden, diminished hospital throughput, and increased patient length of stay.⁶˒⁷˒¹¹˒⁴
Finding the right balance means selecting the monitoring approach that best matches the patient’s clinical needs. For patients who do not require continuous ECG monitoring, wearable monitoring devices provide an alternative that supports earlier recognition of clinical deterioration and may result in reduced rapid response team activations and fewer unplanned ICU admissions.¹⁹
Wearable solutions such as the BioButton® enable continuous monitoring of vital signs with high clinical accuracy and support early detection of patient deterioration.¹⁸
Interested in learning how wearable monitoring approaches like the BioButton® can support continuous vital sign monitoring within your patient care strategy?
See how the BioButton® fits into your patient monitoring strategy at Medtronic.com/BioButton.
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2018;178(7):971-978. doi:10.1001/jamainternmed.2018.2409
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2014;8:29. doi:10.1186/1754-9493-8-29
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6. ECRI. Top 10 Health Technology Hazards for 2023: Executive Brief. ECRI; 2023.
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2023;12:e002342. doi:10.1136/bmjoq-2023-002342
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10. Hillman DR. Sleep loss in the hospitalized patient and its influence on recovery from illness and operation. Anesth Analg. 2021;132(5):1314-1320. doi:10.1213/ANE.0000000000005323
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14. Chaudhary R, Kingsley T, Sarkar S, et al. Telemetry: appropriateness of initial assignment and duration in nonintensive setting. Am J Manag Care.
2020;26(11):459-460. doi:10.37765/ajmc.2020.88524
15. Stellpflug C, Pierson L, Roloff D, et al. Continuous physiological monitoring improves patient outcomes: a nurse-led initiative enhances vital sign assessment using digital devices. Am J Nurs. 2021;121(4).
16. Vroman H, Mosch D, Eijkenaar F, et al. Continuous vital sign monitoring in patients after elective abdominal surgery: a retrospective study on clinical outcomes and costs. J Comp Eff Res. 2023;12:e220176. doi:10.2217/cer-2022-0176
17. Curry JP, Jungquist CR. A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review. Patient Saf Surg.
2014;8:29. doi:10.1186/1754-9493-8-29
18. Weller GB, Mault J, Ventura ME, et al. A retrospective observational study of continuous wireless vital sign monitoring via a medical grade wearable device on hospitalized floor patients. J Clin Med. 2024;13:4747. doi:10.3390/jcm13164747
19. Eddahchouri Y, Peelen RV, Koeneman M, et al. Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study. Br J Anaesth. 2022;128(5):857-863. doi:10.1016/j.bja.2022.01.036
† The BioButton® multi-parameter wearable device is not intended for critical care monitoring. Patient monitoring technologies should not be used as the sole basis for diagnosis or therapy and are intended only as adjuncts to patient assessment.
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