Ramkumar Satish, Tsoi Edward H, Raghunath Ajay, Dias Floyd F, Li Wai Suen Christopher, Tsoi Andrew H, Mansfield Darren R
Department of General Medicine, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2017 Jul;47(7):754-760. doi: 10.1111/imj.13452.
Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs.
To evaluate the outcomes of guideline-based application of cardiac telemetry.
Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward-based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II - baseline) was completed prior to a 3-month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration.
In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean ± standard deviation (SD) age 73 years ± 14.9, 57% male), whilst 65 patients were included in the intervention (mean ± SD age 71 years ± 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 ± 1.8 vs 2.4 ± 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05).
Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.
心脏遥测的不当使用与患者流量减少和医疗成本增加有关。
评估基于指南应用心脏遥测的结果。
第一阶段涉及对一家三级医院遥测使用情况的前瞻性审计（2011年3月至8月）。收集了遥测指征和临床结果的数据。第二阶段前瞻性纳入了18岁以上需要病房遥测的普通内科患者。由于第二阶段与第一阶段时间相隔较远，在进行为期3个月的干预（2015年5月至8月）之前，完成了一次与第一阶段类似的审计（第二阶段 - 基线）。干预措施包括每日遥测病房查房和基于美国心脏协会指南的入院表格（I类，需遥测；II类，可能需遥测；III类，无需遥测）。研究了患者人口统计学、遥测数据和临床结果。主要终点是III类指征减少的百分比，次要终点包括遥测持续时间。
在第一阶段（n = 200），38%的患者因III类指征入院，临床管理无变化。第二阶段基线共纳入74例患者（平均±标准差（SD）年龄73岁±14.9，57%为男性），而干预组纳入65例患者（平均±SD年龄71岁±18.4，35%为男性）。两组基线特征相似。干预后III类入院率从38%降至11%，P < 0.001。干预与遥测中位持续时间缩短有关（1.8±1.8天对2.4±2.5天，P = 0.047）；然而，两组住院时间相似（P > 0.05）。
基于指南的遥测入院和定期遥测病房查房与不当遥测使用的减少有关。
