In our numerous columns on alarm fatigue and alarm management, weve emphasized that the first place to look to reduce unnecessary alarms is usually telemetry (see our columns for July 2, 2013 , October 2014 , and August 16, 2016 ).
In addition to the beneficial patient safety aspect of reducing unnecessary alarms that might contribute to alarm fatigue, there is also a potential for cost savings. A new study ( ( , ). The cost of telemetry was calculated as $34.28 more per day than a nontelemetry hospital day. They calculated that elimination of inappropriate telemetry days would result in a minimum estimated savings of $37,007 in these 250 patients, and an annual savings of $528,241 overall. Importantly, no cardiac code call occurred on a nontelemetry day (codes on patients not meeting the criteria were for respiratory events rather than cardiac events). Of 16 significant arrhythmias detected by telemetry, all were on appropriate telemetry days. Of 19 significant clinical decisions were prompted by telemetry, only one was on a nontelemetry day.) demonstrates the considerable cost savings when you limit use of telemetry to those patients meeting the AHA/ACA guidelines for telemetry. The researchers reviewed 250 consecutive patients admitted to telemetry capable beds on the general medical-surgical, noncritical care units at a tertiary care hospital. Only 24% of telemetry days were deemed appropriate based on the American Heart Association Practice Standards for Electrocardiographic Monitoring in Hospital Settings
Many hospitals have never developed local guidelines to help identify which patients should be monitored by telemetry (and which should not). Moreover, criteria for continued monitoring are extremely important because all too often a physician orders telemetry and it gets continued indefinitely. Getting your physician staff involved early in developing your telemetry criteria is the key.
In our October 2014 What's New in the Patient Safety World column at Christiana Care Health System that successfully implemented a system that significantly reduced unnecessary non-ICU telemetry and achieved substantial financial savings while not adversely impacting patient safety ( we cited a study ). A multidisciplinary team designed the program and ensured appropriate training of impacted departments. The key component was hardwiring the AHA guidelines into their electronic ordering system. Providers were now required to choose an indication from a list, each of which included a duration based upon the AHA guidelines. In addition, they removed telemetry orders from order sets for conditions where monitoring was not supported by the AHA guidelines. Also, guidelines were established for automatic discontinuation of telemetry monitoring.
Focusing on unnecessary telemetry monitoring can lead to significant financial savings without sacrificing patient safety and likely reducing alarm fatigue.
Prior Patient Safety Tips of the Week pertaining to alarm-related issues:
Chong-Yik R, Bennett AL, Milani RV, Morin DP. Cost-Saving Opportunities with Appropriate Utilization of Cardiac Telemetry. Am J Cardiol 2018; 122, Issue 9, Pages 15701573
Drew BJ, Califf RM, Funk M, Kaufman ES, Krucoff MW, Laks MM, Macfarlane PW, Sommargren C, Swiryn S, Van Hare GF, American Heart Association, Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young [published correction appears in Circulation. 2005;111:378]. Circulation 2004; 110: 2721-2746
Sandau KE, Funk M, Auerbach A, et al. AHA Scientific Statement. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136: e273-e344 Originally published October 3, 2017
Dressler R, Dryer MM, Coletti C, et al. Altering Overuse of Cardiac Telemetry in NonIntensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines. (Research Letter). JAMA Intern Med 2014; published online first September 22, 2014