这位患者需要进行遥测监测吗？对一家学术医疗中心遥测监测医嘱开具实践的分析。

Does this patient need telemetry? An analysis of telemetry ordering practices at an academic medical center.

作者信息

Chen Stephanie, Palchaudhuri Sonali, Johnson Amber, Trost Jeff, Ponor Ileana, Zakaria Sammy

机构信息

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Providers for Responsible Ordering, Baltimore, MD, USA.

出版信息

J Eval Clin Pract. 2017 Aug;23(4):741-746. doi: 10.1111/jep.12708. Epub 2017 Jan 27.

DOI:10.1111/jep.12708

PMID:28127832

Abstract

INTRODUCTION

The American Heart Association and Choosing Wisely campaign recommend guideline-based usage of telemetry. Inappropriate use leads to increased costs, alarm fatigue, and inefficient nursing care. This study assesses provider ordering practices for telemetry at a US-based academic hospital.

METHODS

This retrospective study includes all telemetry orders in the medicine and progressive care units from April 2014 to March 2015. Indications were grouped into categories per American Heart Association guidelines.

RESULTS

The top 3 cardiac indications included angina/acute coronary syndrome (35.3%), arrhythmias (19.7%), and heart failure (10.2%). However, noncardiac indications accounted for 20.2% of orders, including respiratory conditions (17.4%), infection (17.4%), substance abuse (14.0%), bleeding (12.4%), vital sign monitoring (10.4%), altered mental status (7.0%), and pulmonary embolus/deep vein thrombosis (7.0%).

CONCLUSIONS

One-fifth of patients were monitored on telemetry for noncardiac indications. We recommend further study on the benefits and risks of telemetry in these patients and systems-based changes for appropriate usage.

摘要

引言

美国心脏协会和明智选择运动建议根据指南使用遥测技术。不当使用会导致成本增加、警报疲劳和护理效率低下。本研究评估了一家美国学术医院中医生开具遥测检查的情况。

方法

这项回顾性研究纳入了2014年4月至2015年3月内科和进阶护理病房的所有遥测检查医嘱。根据美国心脏协会指南，将适应症进行分类。

结果

前三大心脏适应症包括心绞痛/急性冠状动脉综合征（35.3%）、心律失常（19.7%）和心力衰竭（10.2%）。然而，非心脏适应症占医嘱的20.2%，包括呼吸系统疾病（17.4%）、感染（17.4%）、药物滥用（14.0%）、出血（12.4%）、生命体征监测（10.4%）、意识状态改变（7.0%）以及肺栓塞/深静脉血栓形成（7.0%）。