Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email:
Am J Manag Care. 2020 Nov;26(11):459-460. doi: 10.37765/ajmc.2020.88524.
Inappropriate use of telemetry monitoring is associated with alarm fatigue, an increase in health care expenditures, and the potential for patient harm from interventions in clinically inconsequential arrhythmias. We explored adherence to current guidelines for appropriateness of (1) initial telemetry assignment and (2) duration of the assignment.
Retrospective study.
After institutional review board approval, 695 consecutive adult patients (≥ 18 years) who were admitted with any diagnosis to general medical floors and assigned telemetry at the time of admission over 3 months were enrolled. Patients on surgical service and transferred from critical care were excluded. Data were collected from electronic health records (EHRs).
We observed that 155 of 695 (22.3%) patients had been inappropriately assigned telemetry at the time of initial assignment. Of the 540 patients appropriately assigned telemetry, 56.3% of patients had longer than the recommended duration of telemetry monitoring with a median (interquartile range) of 3 (2-4) nonindicated days per patient. The annualized additional cost of telemetry monitoring due to the inefficient utilization was found to be more than $500,000 per year.
Our data further support the need for frequent reassessment of telemetry indication, which can be facilitated by the utilization of EHR-based automated monitoring.
遥测监测的不当使用与报警疲劳有关，这会增加医疗保健支出，并有可能对临床无意义心律失常患者造成干预伤害。我们探讨了当前关于（1）初始遥测分配和（2）分配持续时间的适宜性指南的遵守情况。
回顾性研究。
在获得机构审查委员会批准后，我们纳入了在 3 个月内接受任何诊断并在入院时被分配遥测的 695 例连续成年患者（≥18 岁）。排除了外科服务的患者和从重症监护室转来的患者。数据从电子健康记录（EHR）中收集。
我们观察到，在初始分配时，有 155/695（22.3%）名患者被不当分配了遥测。在 540 名被适当分配遥测的患者中，有 56.3%的患者的遥测监测时间超过了推荐时间，中位数（四分位距）为每患者 3（2-4）天。由于效率低下的利用，每年遥测监测的额外成本超过 50 万美元。
我们的数据进一步支持了频繁重新评估遥测指征的必要性，这可以通过利用基于 EHR 的自动化监测来实现。
