American Heart Association (AHA) guidelines for the use of telemetric EKG monitoring focus primarily on patients admitted with cardiac diagnoses. There is limited data to guide the use of telemetry in patients admitted with general medical diagnoses, such as GI bleed or pulmonary embolism.
We carried out a prospective, observational study of adults admitted to a general medicine service and placed on telemetry monitoring during three nonconsecutive months. Data on patient characteristics were collected from the electronic medical record. Telemetry events were collected daily from telemetry technician written records. Data on rationale for telemetry use as well as management changes in response to telemetry events were collected from surveys.
One hundred patients were admitted to telemetry during our study time period. The most common admitting diagnosis in these patients was GI bleed (19%). Sixtyeight percent of patients had sinus rhythm or sinus tachycardia on admission. Fifty percent of the admitting physicians surveyed responded that they ordered telemetry to detect clinical deterioration early. Fortytwo percent of patients had one or more telemetry events, most commonly sinus bradycardia, sinus tachycardia, or premature ventricular contractions. Four patients developed atrial flutter or atrial fibrillation. Two patients required ICU transfer as a result of a telemetry event and the AHA class I criteria would have excluded both of these patients from placement on telemetry.
Although physicians order telemetry in order to be aware of clinical deterioration early, significant arrhythmias are uncommon among general medical patients. AHA criteria may not accurately predict patients at risk for arrhythmias in this patient population.
To cite this abstract:Auerbach A, Najafi N. Utilization and Outcomes of Telemetric Ekg Monitoring on a Medicine Service. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97669. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/utilization-and-outcomes-of-telemetric-ekg-monitoring-on-a-medicine-service/. Accessed September 17, 2019.