What is Telemetry and Why It's Being Overused

What is Telemetry

Telemetry is continuous cardiac monitoring (CCM), an option introduced to hospitals in the 1950s to monitor the development of an arrhythmia, myocardial ischemia, and observe changes in QT intervals in cardiac patients in the Intensive Care Unit (ICU) ¹. 

Why Telemetry is Being Overused

Over the years, telemetry monitoring has moved away from the acute care setting and into specialized telemetry units and onto general medicine floors with remote telemetry capabilities⁴. According to recent studies, more than fifty percent of patients ordered telemetry lacked relevant cardiac histories or medical indications for CCM, according to the American Heart Association (AHA) guidelines initially set in 2004⁴. One study predicts that the average hospital can expect to pay over 250,000 unnecessary expenses related to CCM. The increasing misuse of patients inappropriately being ordered telemetry is expensive not only to the hospitals and clinicians, but the patients are paying a high price too. Telemetry contributes to decreased patient satisfaction, and increased instances of delirium for elderly patients prescribed telemetry, often resulting in extended length of patient stays, further increasing the cost of healthcare⁵. In response to increased healthcare cost and clinician alarm fatigue and decreased patient satisfaction, the AHA updated its telemetry recommendations and guidelines in 2017⁶. 

Often physicians are ordering telemetry as a safety net for their patient rather than its intended purpose.² Unfortunately, CCM does not provide the additional safety net physicians assume; one hospital completed a study showing that as little as three percent of significant clinician interventions resulted from patients being monitored on telemetry.² To decrease telemetry overutilization, one facility found they could reduce their telemetry utilization by seventy percent without impacting patient care or outcomes by only adhering to the AHA recommendations when providing care ⁴. The overutilization of telemetry reveals that physicians would like to have additional monitoring capabilities outside of the acute care settings but currently have limited options outside of the telemetry order in most instances. Telemetry is very limited in providing relevant information to the clinician. In most instances of clinical deterioration, observations of vital signs trends and observations of clinical signs are the source of most clinical interventions and changes in patient care⁴. 

Surveillance Monitoring May Be a Better Choice

Surveillance monitoring provides an additional monitoring option that saves the hospital money, increases patient satisfaction, and improves workflow for the clinician. The ViSi Mobile system provides the clinician continuous monitoring of critical vital signs, capturing vitals and hemodynamic status changes before the patient develops an arrhythmia due to the clinical deterioration. Changes in heart rate, blood pressure, respiration, oxygen saturation, and posture can be monitored in real-time on medical-surgical and other patient care units, providing an additional layer of safety for clinicians and patients in a cost-effective solution. 

References

1. Johnny Chahine; Bicky Thapa; Falgun Gosai; Bahaa Abdelghaffar; Suleiman I Al Ashi; Anjli Maroo; Narendrakumar Alappan; and K V Gopalakrishna. (2019, March 25). Interventions to Decrease Overuse of Cardiac Monitoring (Telemetry) When Transitioning from the Intensive Care Unit to the Regular Nursing Floor.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538103/
2. Debbie W Chen, Robert Park, Sarah Young, Divya Chalikonda, Kemarut Laothamatas, Gretchen Diemer. (2018, September 13). Utilization of Continuous Cardiac Monitoring on Hospitalist-led Teaching Teams. DOI: 10.7759/cureus.3300 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235649/#:~:text=Telemetry%20was%20introduced%20in%20hospitals,critical%20care%20settings%20%5B1%5D
   Utilization of Continuous Cardiac Monitoring on Hospitalist-led Teaching Teams
3. Bonnie Darves. (2014, December). Cardiac Telemetry: Eliminating Overuse. https://www.todayshospitalist.com/cardiac-telemetry-eliminating-overuse/
4. Mary Lacy, MD Keith Davis, MD Kirsten Tolstrup, MD Patrick Rendon, MD. (2015, November) When Should Hospitalists Order Continuous Cardiac Monitoring? https://www.the-hospitalist.org/hospitalist/article/122074/when-should-hospitalists-order-continuous-cardiac-monitoring
5. Sima S. Pendharkar, MD, MPH, Ibrahim B. Barry, MD, MPH, Saikrishna Patibandla, MD, MS, Tiffany I. Leung, MD, MPH, Amol Gupta, MBBS, Aung Naing Lin, MD, James A. Gasperino, MD, Ph.D., MPH. (2020, November 10). AHA Telemetry Guidelines Improve Telemetry Utilization in the Inpatient Setting. https://doi.org/10.37765/ajmc.2020.88525
   https://www.ajmc.com/view/aha-telemetry-guidelines-improve-telemetry-utilization-inthe-inpatient-setting
6. Dr. Fatima Shahid. (2019). HVPAA National Conference. A Multidisciplinary Approach to Tackling Telemetry Overuse. https://www.the-hospitalist.org/hospitalist/article/122074/when-should-hospitalists-order-continuous-cardiac-monitoring