Using Surveillance Monitoring as a Catalyst for Change: Decreasing Over-Utilization of Telemetry Monitoring

Remote telemetry monitoring is utilized in the acute care setting to monitor cardiac rhythms outside of cardiac, critical care, or progressive care settings. Over-utilization of remote telemetry is well documented in the literature, despite published recommendations from the American Heart Association (AHA) (2017) and others (Dhillon, 2009; Sandau et al., 2017; Dressler, 2014). This overuse can increase hospital costs, delay flow of patients due to lack of available telemetry monitors and increase nursing time with various telemetry-related tasks (Benjamin et al., 2013). Patient Safety Net (PSN) is a type of surveillance technology that can offer an alternative approach to telemetry monitoring for medical-surgical patients. Patients on general medical and surgical units are at an increased risk of clinical deterioration from unrecognized complications (Taenzer & Blike, 2012). By using surveillance technology, patients have continuous pulse oximetry (SpO2) and heart rate (HR) monitoring and anytime there is an abnormality outside of the normal range, the nursing staff is notified.

In June 2018, a six-month IRB approved pilot study began on a 44-bed medical unit. A wireless surveillance device was installed, and education was provided for RNs and MDs to promote utilization of this device. This system provided a wearable device nurses could place on a patient’s arm to monitor continuous HR and O2 saturation. Additionally, patients could be monitored during ambulation and transport. All patients admitted to the pilot unit were placed on the PSN device. Once the unit reached 90% PSN utilization for two weeks, the study moved into Phase II. Phase II started September 24^th, 2018 with the implementation of a nurse-driven telemetry removal intervention for patient’s not meeting AHA criteria and will run through the end of December 2018. All patients admitted/transferred to the pilot unit with an order for telemetry monitoring were assessed by the RN to see if they met AHA criteria using a telemetry assessment form. If the patient did not meet criteria, the RN discontinued the order and did not place the patient on telemetry monitoring. The purpose of this pilot study is to decrease inappropriate telemetry utilization through implementation of a nurse-driven intervention utilizing AHA ECG monitoring criteria and replacing telemetry with a surveillance device. Preliminary data has been calculated showing a decrease in telemetry days and overall cost for less patients being placed on telemetry. No adverse outcomes have been noted. Final data from the study is pending.