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Patient Safety Tip of the Week

February 7, 2023

Reducing Unnecessary Telemetry



When hospitals ask “Where should we start?” in addressing alarm fatigue, we always tell them the first place to look is at unnecessary telemetry. There are two key elements in programs to reduce such use:

·       Only begin telemetry in patients who meet accepted guidelines for telemetry use

·       Stop telemetry once patients no longer meet criteria for continued use


A hospital system recently did just that (Patidar 2022). They did 2 key interventions across 4 hospitals (a large academic quaternary center, a tertiary care center, a small community hospital, and a large community hospital) with a total of 1700 beds. The 2 key elements were:

·       Hardwiring the 2017 American Heart Association practice guidelines on the appropriate use of telemetry into their EHR-based protocol for telemetry

·       Developing a nursing-driven discontinuation protocol with an electronic nursing screening task form for safe discontinuation of telemetry


There was a statistically and clinically significant 24% decrease in telemetry duration between pre- and post-intervention time periods (P < 0.0001). Mean telemetry duration was 4.11 and 2.36 days in pre- and post-intervention periods, respectively, a 1.75 day reduction across each of the four hospitals.


The authors projected a substantial cost avoidance from this project. Though they did not measure it, there was also likely also a substantial reduction in alarm fatigue as a result of the project.


The Patidar article details the project planning by a multidisciplinary team and the communication rollout that was important in preparing for the implementation of the automated protocol.


The results are remarkably similar to a program we highlighted in our October 2014 What's New in the Patient Safety World column “Alarm Fatigue: Reducing Unnecessary Telemetry Monitoring”, in which researchers at Christiana Care Health System successfully reduced unnecessary non-ICU telemetry and achieved substantial financial savings while not adversely impacting patient safety (Dressler 2014). 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. After implementation there was a 70% reduction in the mean daily number of patients being monitored by telemetry. The mean weekly number of telemetry orders dropped 43% and the mean duration of telemetry dropped by 47%.


Another striking reduction in telemetry was achieved on a hospitalist service (Edholm 2018). Interventions included education, process change, routine feedback, and a financial incentive. A system-wide change to the telemetry ordering process was also introduced without the other components. Among hospitalist service patients, telemetry utilization was reduced by 69%. On the non-hospitalist services the reduction was a less marked 22%. There were no significant increases in mortality, code event rates, or care escalation, and there was a trend toward improved utilization appropriateness. The EHR telemetry order was modified to discourage unnecessary telemetry monitoring. The new order required providers ordering telemetry to choose a clinical indication and select a duration for monitoring, after which the order would expire and require physician renewal or discontinuation. These were the only changes that occurred for nonhospitalist providers.


The authors also noted there had been an immediate decrease in telemetry orders after removing the telemetry order from their admission order set. They also attributed success on the hospitalist service to standardization of rounds to include daily discussion of telemetry and the provision of routine feedback. They could not discern whether other components of the program (such as the financial incentives) contributed more or less to the program, though the sum of these interventions produced an overall program that required substantial buy in and sustained focus from the hospitalist group.


Our own take on these programs is that there are some key success factors:

·       A multidisciplinary team must be involved in planning and implementation

·       There should be clinical champions from both your medical and nursing staffs

·       Evidence-based guidelines for telemetry use need to be integrated into your electronic health record ordering process

·       A strong communication program prior to rollout

·       Your medical staff must buy into the concept of either automatic discontinuation or a nurse-driven discontinuation process

·       Your nursing staff must be confident in that nurse-driven discontinuation process and not fear retribution from medical staff

·       You need to measure desired outcomes and give feedback to all stakeholders


Though such programs likely achieve significant financial savings, you staffs are more likely interested in outcomes other than financial ones. Though measurement of alarm fatigue is difficult, you can at least do informal surveys of stakeholders about the perceived benefit as it pertains to alarm fatigue.



Prior Patient Safety Tips of the Week pertaining to alarm-related issues:


·       March 5, 2007 “Disabled Alarms”

·       March 26, 2007 “Alarms Should Point to the Problem”

·       April 2, 2007 “More Alarm Issues”

·       June 19, 2007 “Unintended Consequences of Technological Solutons”

·       April 1, 2008 “Pennsylvania PSA’s FMEA on Telemetry Alarm Interventions”

·       February 23, 2010 “Alarm Issues in the News Again”

·       March 2, 2010 “Alarm Sensitivity: Early Detection vs. Alarm Fatigue”

·       March 16, 2010 “A Patient Safety Scavenger Hunt”

·       November 2010 “Alarms in the Operating Room”

·       February 22, 2011 “Rethinking Alarms”

·       February 2013 “Joint Commission Proposes New 2014 National Patient Safety Goal”

·       May 2013 “Joint Commission Sentinel Event Alert: Alarm Safety”

·       July 2, 2013 “Issues in Alarm Management”

·       August 2013 “Joint Commission Formalizes 2014 NPSG on Alarm Management”

·       February 4, 2014 “But What If the Battery Runs Low?”

·       October 2014 “Alarm Fatigue: Reducing Unnecessary Telemetry Monitoring”

·       December 15, 2015 “Vital Sign Monitoring at Night”

·       February 9, 2016 “It was just a matter of time…”

·       August 16, 2016 “How Is Your Alarm Management Initiative Going?”

·       February 21, 2017 “Alarm Fatigue in the ED”

·       April 18, 2017 “Alarm Response and Nurse Shift Duration”

·       April 25, 2017 “Dialysis and Alarm Fatigue”

·       October 17, 2017 “Progress on Alarm Management”

·       November 21, 2017 “OSA, Oxygen, and Alarm Fatigue”

·       May 1 2018  “Refrigerator Alarms”

·       April 16, 2019 “AACN Practice Alert on Alarm Management”

·       September 2019 “Alarm Fatigue in the Emergency Room”

·       October 8, 2019 “Another Freezer Accident”

·       June 23, 2020 “Telemetry Incidents”

·       August 2020 “Pulse Oximetry in Children”

·       September 15, 2020 “An Eerily Familiar Incident”

·       January 26, 2021 “This Freezer Accident May Cost Lives”



Some of our prior columns on the hazards associated with telemetry:

·       June 19, 2007 “Unintended Consequences of Technological Solutions”

·       April 1, 2008 “Pennsylvania PSA’s FMEA on Telemetry Alarm Interventions”

·       February 23, 2010 “Alarm Issues in the News Again”

·       July 2011 “What's New in the Patient Safety World”

·       February 4, 2014 “But What If the Battery Runs Low?”

·       May 22, 2018 “Hazardous Intrahospital Transport”

·       June 23, 2020 “Telemetry Incidents”






Patidar V, Park JM, Khasnavis T, et al. Evaluation of a Multifaceted Protocol in Reducing Unnecessary Telemetry Monitoring Across a Large Healthcare System. South Med J 2022; 115(12): 930-935



Dressler R, Dryer MM, Coletti C, et al. Altering Overuse of Cardiac Telemetry in Non–Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines. (Research Letter). JAMA Intern Med 2014; 174(11): 1852-1854 published online first September 22, 2014




Edholm K, Kukhareva P, Ciarkowski C, et al. Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health Record Change and a Multifaceted Hospitalist Intervention. Journal of Hospital Medicine 2018; 13: 531-536





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