Lessons Learned from Efforts to Reduce Overuse of Cardiac Telemetry Monitoring

摘要

Background: Inappropriate use of telemetry monitoring is common, increasing costs, false alarms, and length of stay. TheSociety of Hospital Medicine and Choosing Wisely encourage the use of discontinuation protocols.Methods: This quality improvement initiative measured the impact of an educational intervention and distribution ofperformance reports for physicians and residents on the general medicine ser vice. The inter vention group received a 15-minute didactic session on appropriate indications for telemetry followed by weekly performance reports for 78 weeks. Asegmented linear regression model and Student’s t -test were used to determine intervention effects on percentage of patientson telemetry and telemetry orders lasting more than 48 hours.Results: Prior to the intervention, 4.8% of patients received telemetry monitoring; 13.4% of telemetry orders exceeded 48hours. The control service had a baseline telemetry utilization of 2.4%; 1.2% of telemetry orders exceeded 48 hours. After theintervention, 3.9% of patients received telemetry monitoring; 10.6% of telemetry orders exceeded 48 hours. The controlservice had a postintervention telemetry utilization of 2.1%; 1.1% of telemetry orders exceeded 48 hours. The Student’st -test showed a statistically significant ( p = 0.002) decrease in telemetry ordering rate on the inter vention ser vice and nosignificant change in the control group. However, when using segmented linear regression analysis, these changes could notbe attributed to the intervention nor were there any significant changes in balancing metrics.Conclusion: Education and weekly performance feedback did not significantly impact telemetry according to segmentedlinear regression results. Segmented linear regression analysis of an interrupted time series yielded significantly differentresults from a pre-post comparison using Student’s t-test. Rigorous evaluation is vital to decreasing unnecessary care andsuccessful reduction in unnecessary care may require interventions that capitalize on systems-level change.