Christiana Care Health System (CCHS) is a 1100bed hospital system with all telemetry enabled beds. Continuous cardiac monitoring (CCM) is ordered for a default period of 72 hours at the time of admission on patients by admitting physicians even if the intention is to monitor only for the first 2448 hours. Physicians are not prompted to review or discontinue tele orders as needed on a daily basis. As a result, unintentional over monitoring of patients leads to a significant work burden on nursing units. This added to the associated costs of telemetry prompted an intervention to decrease the same.
The primary aim of this project is to decrease the average number of tele days per patient on a medical unit by 10% over a 3month period using daily notification to physicians of telemetry orders by floor staff.
The intervention was performed in 2 two phases. Phase 1 started with review of CCM guidelines and indications to continue monitoring with nursing staff. All tele patients were identified by placing a red heart sticker on the spine and face of patient’s chart noting the date of expiration to act as a visual cue for physicians to review tele orders. Phase 2 started 6 weeks later with a telemetry query sticker placed in chart in the provider communication form that is used by various disciplines for nonurgent questions to physicians. The query sticker asked physicians to review the telemetry order and discontinue if they agreed or renew after the 72 hour expiry period. Nurses were trained to ask physicians to review tele orders if patients had no chest pain, arrhythmias or cardiac enzyme elevations in the previous 24 hours per CCHS guidelines.
Baseline data on telemetry was obtained based on finance charges over a 5 month period. 854 patients were monitored during that time period with an average of 2.60 tele days per patient. The case mix index (CMI) was 1.03. The average unit length of stay (LOS) was 3.85 days. One week after the initiation of phase 2 data was collected again for the total of 7 weeks. The intervention group consisted of 269 tele patients. The average unit LOS for this group was 3.52 days with a CMI of 1.16. The average number of tele days was 1.86 days. This accounts for a 28% reduction in average tele days after the intervention for a slightly higher CMI. Random audits for compliance with sticker process on four different days showed an average of 70% compliance. We think that frequent review of tele orders by physicians is important to ensure the appropriateness of CCM as it is a resource and expense intensive tool for hospitalized patients. We think that a visual cue is important for physicians to review tele orders, the project is continuing at this time and we think that ultimately a computerized solution will be put in place.
To cite this abstract:Marandola B, Tambourelli B, Harris D, Mahoney D, Dozier J, Herbstritt J, Ramdoss V, Bhamidipati V. Daily Review of Telemetry Orders by Providers Leads to Improved Appropriateness of Use of Telemetry. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97745. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/daily-review-of-telemetry-orders-by-providers-leads-to-improved-appropriateness-of-use-of-telemetry/. Accessed May 23, 2019.