Journal Article

36 In-hospital telemetry audit – a single tertiary centre experience

Jain, D, Reynolds, S, Sheahan, R, Newsome, F

2023

Overview

IntroductionInpatient telemetry monitoring makes up a large portion of non-invasive cardiology investigations available to general medical teams. Studies have shown that clinical care changes in 7–30% of patients may be attributed to telemetry findings. Overuse of telemetry amongst hospital patients results in longer waiting times for telemetry to other patients, prolongs length of admission and cost of healthcare. Although some centres have local proformas regarding the use of this limited resource, there are no standardised guidelines regarding its use in Irish hospitals. Furthermore, there is a lack of European guidelines on telemetry use.Aims and MethodsProspectively analyse the inpatient telemetry requests and use over a 60-day period in a single centre to identify areas of improvement. The aim of the audit was to create a standardised proforma for prioritisation of telemetry requests using American Heart Association (AHA) and British Heart Rhythm Society (BHRS) telemetry guidelines. Consecutive data was prospectively collected on telemetry use in a single centre using electronic health systems and patient records.ResultsA total of 10,796 telemetry hours of data was recorded and reviewed from 241 patients during the period. Demographics as per table 1. The mean time waiting for telemetry was 23.1hrs (+/- 21.8hrs). The mean time on telemetry was 44.8hrs (+/- 39.3hrs) with 0.385 arrythmias per telemetry day or 77 patients (32%) with an arrythmia detected. There was a change in management enacted in 70 patients (29%) due to telemetry findings. This included titration of medications in 54 patients (22%), diagnosis of new atrial fibrillation in 14 patients (5.8%), further diagnostics in 14 patients (5.8%), reversion to sinus rhythm in 9 patients (3.7%) and device insertion in 4 patients (1.6%). A total of 30 patient requests did not receive telemetry, 6 patients had telemetry refused due to inappropriate requests, 4 patients refused telemetry when offered to them, 14 patients had been discharged home when a box was assigned to them, 6 patients had electrolytes that had normalised prior to telemetry being made available. 202 (84%) of requests met criteria for telemetry according to BHRS and AHA guidelines. Of the 39 requests that did not meet criteria for telemetry as per guidelines, there was a change to patient management based on findings in 4 cases. 6 requests were monitored for shorter than the recommended duration. 66 telemetry requests were monitored for longer than the recommended duration.Abstract 36 Table 1Patient demographicsConclusionsTelemetry monitoring in-hospital is a valuable but limited resource with potential for overuse. Judicious telemetry use with suggested prioritisation (figure 1) and prescription of telemetry rather than automatic approval may result in better patient outcomes. A re-audit to complete the process after hospital staff education and implementation of new telemetry form will be carried out to evaluate the results.Abstract 36 Figure 1Telemetry use with suggested prioritisation[Figure omitted. See PDF]

• Publisher: BMJ Publishing Group LTD
• Subject: Patients / Telemetry