Background:
Telemetry was first introduced in the 1950s in cardiac intensive care units (ICU) and has since expanded to beyond the ICU setting. With this expansion, concerns regarding the overutilization of telemetry have emerged. In response to these concerns, the American Heart Association (AHA) and the American College of Cardiology (ACC) released guidelines for evidenced-based telemetry utilization in 2004. Following this publication, numerous studies have shown that a significant number of non-ICU patients on telemetry do not meet evidenced-based indications leading to costly overutilization of a valuable resource. This overutilization is expensive in both the direct costs of equipment and labor as nurses spend an average of 20 minutes per patient day on telemetry related tasks. As healthcare expenditures in the United States continue to rise, efforts are needed to contain these rising costs if we wish to continue to provide high quality, affordable care.
Methods:
Using the electronic medical record (EMR) at our urban, tertiary-care, 482 bed teaching hospital, we performed an observational study looking at all admissions to a medical floor that were ordered telemetry in June 2019. We investigated if telemetry was ordered based upon the 2004 AHA guidelines. We then examined the total duration of telemetry utilized for non-AHA guideline indications. Next, we applied the average additional daily cost of $53.44, as reported in the literature, for monitored vs. non-monitored patients and then calculated an estimated total monthly expenditure for inappropriate use to cardiac monitoring. Annual costs were then projected based upon this figure.
Results:
There were 395 patients admitted in June 2019. After all inclusion criteria were applied, our sample consisted of 226 patients. Seventy-nine of these patients had telemetry ordered for an AHA guideline-based indication, while 147 patients had telemetry ordered for a non-AHA guideline indication for a total of 711 patient days, which adds $37,995.84 to monthly healthcare expenditures. Of the 147 patients that had telemetry ordered for non-AHA guideline indications, only one patient had a documented benefit, which was the detection of new-onset paroxysmal atrial fibrillation.
Conclusions:
Telemetry monitoring is frequently overused for patients admitted to non-critical care services. An effort to educate House Staff about the indications for ordering telemetry based on AHA guidelines can reduce healthcare-associated costs and help provide cost-effective, high-quality care to our patients.
Safe Deliveries?: a Review of New Zealand's Midwifery Regulation through the Lens of the Health and Disability Commissioner
