Telemetry use has escalated in hospitals in general, causing some unexpected problems including a tethering effect for patients, with reduction of ambulation, potential for increased falls, and even a potential for increased length of hospitalization. There is an unrealistic belief that patients on heart monitors are safer. A survey of nursing staff at the university was undertaken to validate the current state because of an unexpected demand for services. Results of nursing surveys at the university indicated that 57% of staff used the standby feature for telemetry on a daily basis, whereas 53% reviewed the events once or twice in 8 hours. Many patients were ordered heart monitors without a clear indication, and monitors were not continuously watched.
An inclusive institutional interdisciplinary evidence‐based initiative was developed to assess inpatient cardiac monitoring practices and to reduce sentinel events through the appropriate use of telemetry at Penn State Hershey College of Medicine.
This project used the Triad model integrating nursing clinical expertise with best external research evidence while accounting for provider preferences in order to deliver quality care. American Heart Association guidelines were adopted as the best‐practice standard. Nursing and physician champions were identified. Educational programs were presented to all clinical departments. An interdisciplinary team designed the implementation process. Cardiology and ICU/CCU‐level patients were excluded from the reduction process. Monitor use was assessed by the clinical nursing staff on a daily basis. Patients who did not fit the guidelines were targeted for discontinuation of telemetry at 48 hours. Initially, calls were made to providers to ask for consideration of discontinuation of telemetry. After 3 months, a courtesy call was made to physicians to notify them of discontinuation. After 6 months, the guidelines were fully implemented. The process was quality driven and encouraged nursing to staff to discontinue monitors only if there was no indication of clinical need.
During the process, monitor orders were reduced from 1241 to 585 orders over 4 quarters. Financial savings to the institution were substantial, with results pending at the time of submission. Sentinel events had averaged 1 per year; there were none over the course of the year of implementation. The process has resulted in consideration of other nursing‐driven protocols for expedited care progression.
B. L. Hoffmann ‐ none; A. Moyer ‐ none
To cite this abstract:Hoffmann B, Moyer A. Leading Quality Change One Beat at a Time: Telemetry Reduction in a University Hospital. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 175. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/leading-quality-change-one-beat-at-a-time-telemetry-reduction-in-a-university-hospital/. Accessed March 28, 2020.