Abstract
Introduction: Cardiac telemetry is an expedient way to monitor and detect arrhythmias and has become a vital part of patient care. Managing the appropriate utilization of cardiac telemetry, however, is a core challenge in hospitals across the United States. Telemetry is often overused in hospitalized patients, either prolonged past suggested monitoring timeframes or unnecessarily initiated in low risk patients. Overutilization continues to be a significant source of health system waste and is considered a leading area in need of improvement. The number of days spent on telemetry is a clear component in rising hospital operating costs and often contributes to bed shortages and other resource limitations. Evidence suggests that decreasing telemetry stays provides an opportunity for institutions to safely reduce costs, increase patient satisfaction, and save providers time and effort, while maintaining, and potentially increasing, patient safety. It is anticipated that with the successful implementation of a telemetry rounding team to evaluate the need for telemetry on patients, proper utilization will occur.
Methods: A process improvement project was designed so that patients could be daily assessed regarding the need for continued telemetric care. This quantitative, quality improvement study examined whether a telemetry rounding team rounding on telemetry units would decrease the number of days patients remained on telemetry. The cardiology nurse practitioner, unit nurse manger, and the patient’s primary nurse, made up the telemetry rounding team and had a clear understanding of their roles and responsibilities. Permission to perform the study was obtained from the Chief Medical Officer and the Institutional Review Board. The study consisted of provider and nursing staff education and the implementation of telemetry discontinuation guidelines. A telemetry rounding tool, log sheet, and data collection tool were instrumental in accomplishing the outcomes. The sample for this quality and process improvement study included all patients admitted to telemetry, except those transferred to other facilities for further interventions not available at the study site. A convenience sample was used in this study. Data, including the number of telemetry days before implementation and during telemetry rounding, were obtained for comparison. Pre-interventional telemetry data was collected over a three week period prior to the implementation of the project. A total of 150 patients were evaluated for length of stay on telemetry during this time. The duration of telemetry was then tallied again for another three weeks with the same number of patients, this time with the execution of telemetry rounding.
Results: The unit of analysis in this quality improvement study was the telemetry patients, although data at the provider level, including the professional class (i.e. physician, physician assistant, and nurse practitioner) of the provider that ordered the telemetry and whether a cardiologist was consulted for the patient, were also included. The study’s dependent variable was the duration of telemetry, which was measured in hours at the patient level. The duration of telemetry was computed for the entire sample of 300 telemetry patients: 150 patients in a three-week period prior to the telemetry rounding intervention and 150 patients during the execution of telemetry rounding. The effect of the intervention on the duration of telemetry, in hours, was tested using bivariate and multivariable analysis. The bivariate analysis compared the mean telemetry duration prior to the intervention and during the intervention using an independent-samples t-test (two-tailed test). The multivariable analysis applied a linear regression, wherein factors other than the intervention were “controlled” so that their association with the outcome was not misattributed to the intervention. The mean telemetry duration prior to the intervention was 98.11 hours, whereas during the intervention, it decreased to 52.09 hours. The change in average telemetry duration was, therefore, -46.02 hours, a statistically significant reduction (p < .001). The final analysis revealed that the telemetry rounding intervention did yield a statistically significant decrease in the duration of telemetry hours when pre-intervention and interventional data were compared.
Conclusions: Improper utilization of telemetry is a serious problem that may lead to poor patient outcomes and wasted health resources. Reducing or eliminating improper telemetry practices can improve patient health outcomes and help protect valuable health care resources. Continuous health care reform warrants efficient and cost-effective health care practices. This quality/process improvement project was conducted to examine whether having a telemetry rounding team rounding on telemetry patients would affect the number of days patients remained on telemetry. This effort to reduce the use of telemetry on non-indicated days was explored with a positive impact on length of stay. Since the main objective of the study was to decrease the length of stay in the telemetry unit and results reflected a significant decline, telemetry rounding was adopted as current institutional practice. The findings also showed that more positive outcomes could be achieved when the telemetry rounding team has a clear understanding of its roles and responsibilities. Thus, sustainable reduction can be best achieved by developing a culture of telemetry stewardship among health care team.