Horwood Chelsea R, Moffatt-Bruce Susan D, Rayo Michael F
aDepartment of Surgery, The Ohio State University Wexner Medical Center, USA,
bDepartment of Surgery and Quality and Operations, The Ohio State University Wexner Medical Center, USA,
Adv Health Care Manag. 2019 Oct 24;18. doi: 10.1108/S1474-823120190000018007.
Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms. A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation. There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% ( = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up ( = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up ( = 0.649). However, there was a significant increase in ED boarding rate of 7.7% ( < 0.001) likely due to other hospital factors altering boarding times. Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.
不恰当的心脏监测会导致医院资源利用增加和警报疲劳，最终对患者安全有害。我们机构实施了一项持续心脏监测（CCM）政策，该政策基于美国心脏协会（AHA）指南，重点对患者进行选择性监测。本研究的主要目标是对选择性CCM政策对整个医疗中心的使用率、住院时间（LOS）和死亡率的纵向影响进行为期三年的中位数随访审查。次要目标是确定针对护理人员进行心脏警报重要性再教育的小规模干预措施的效果。2013年12月，俄亥俄州立大学根据所有患者群体的选择性CCM指南制定了一项全系统政策。患者被分为危急I级、II级和III级，分别进行72小时、48小时或36小时的CCM。实施前后的测量指标包括平均心脏监测天数（CMD）、急诊科（ED）留观率、死亡率和LOS。在实施前、实施后直接以及实施三年后分析了一个为期12周的评估期。实施选择性CCM后，CMD总体下降了53.5%。在三年随访中，这一数字保持稳定，略有增加0.5%（P = 0.2764）。随后按医院类型进行的分析显示，CMD下降幅度最大且最稳定的是非心脏医院。心脏医院CMD的下降在大约一年内保持稳定，然后降至较低的稳定水平九个月，然后恢复到实施后的先前水平。这一变化与在心脏医院进一步降低CMD的较小规模干预措施相吻合。死亡率没有显著变化，随访时略有下降3.1%（P = 0.781）。此外，LOS没有显著差异，随访时略有增加1.1%（P = 0.649）。然而，ED留观率显著增加了7.7%（P < 0.001），这可能是由于其他医院因素改变了留观时间。实施选择性CCM可降低平均心脏监测率，而不影响LOS或总体死亡率。选择性心脏监测也是一种可持续的方式，可降低医院总体资源利用，并更适当地专注于患者护理。
