Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Appl Clin Inform. 2024 Oct;15(5):860-868. doi: 10.1055/s-0044-1789574. Epub 2024 Oct 23.
Telemetry monitoring is crucial for high-risk patients but excessive use beyond practice standards increases costs. Prior studies have shown that electronic health record (EHR) alerts reduce low-value telemetry monitoring. However, specific components of these alerts that contribute to effectiveness are unknown.
We aimed to revise previously implemented EHR Best Practice Advisories (BPAs) to optimize their effectiveness in reducing telemetry duration. The secondary objective was to assess the impact on clinicians' alert burden.
A multicenter retrospective study was conducted at Johns Hopkins Hospital (JHH), Johns Hopkins Bayview Medical Center (JHBMC), and Howard County General Hospital (HCGH). An EHR alert in the form of a BPA was previously implemented at JHH/JHBMC, firing at 24, 48, or 72 hours based on order indication. HCGH used an alert firing every 24 hours. A revised BPA was implemented at all hospitals optimizing the prior JHH/JHBMC alert by including patient-specific telemetry indications, restricting alerts to daytime hours (8:00 a.m.-6:00 p.m.), and embedding the discontinuation order within the BPA alert. A retrospective analysis from October 2018 to December 2021 was performed. The primary outcome was telemetry duration. The secondary outcome was the mean monthly BPA alerts per patient-day.
Compared with the original BPA, the revised BPA reduced telemetry duration by a mean of 6.7 hours (95% CI: 5.2-9.1 hours, < 0.001) at JHH/JHBMC, with a minimal increase of 0.06 mean monthly BPA alerts per patient-day ( < 0.001). The BPA acceptance rate increased from 7.8 to 31.3% postintervention at JHH/JHBMC ( < 0.0001). At HCGH, the intervention led to a mean monthly reduction of 20.2 hours in telemetry duration per hospitalization (95% CI: 19.1-22.8 hours, < 0.0001).
Optimizing EHR BPAs reduces unnecessary telemetry duration without substantially increasing clinician alert burden. This study highlights the importance of tailoring EHR alerts to enhance effectiveness and promote value-based care.
遥测监测对高危患者至关重要，但超出实践标准的过度使用会增加成本。先前的研究表明，电子健康记录（EHR）警报可减少低价值的遥测监测。然而，这些警报中有助于提高效果的具体组成部分尚不清楚。
我们旨在修订先前实施的电子健康记录最佳实践建议（BPA），以优化其在缩短遥测时间方面的效果。次要目标是评估其对临床医生警报负担的影响。
在约翰霍普金斯医院（JHH）、约翰霍普金斯湾景医疗中心（JHBMC）和霍华德县综合医院（HCGH）进行了一项多中心回顾性研究。以前在 JHH/JHBMC 实施了一种以 BPA 形式出现的 EHR 警报，根据医嘱指示在 24、48 或 72 小时后触发。HCGH 每 24 小时触发一次警报。在所有医院实施了经过修订的 BPA，通过包含患者特定的遥测指示、将警报限制在白天（上午 8:00-下午 6:00）和在 BPA 警报中嵌入停止医嘱，对先前的 JHH/JHBMC 警报进行了优化。进行了从 2018 年 10 月到 2021 年 12 月的回顾性分析。主要结局是遥测持续时间。次要结局是每位患者每天的平均每月 BPA 警报数。
与原始 BPA 相比，在 JHH/JHBMC，修订后的 BPA 将遥测持续时间平均缩短了 6.7 小时（95%CI：5.2-9.1 小时， < 0.001），而每位患者每天的平均每月 BPA 警报数仅增加了 0.06（ < 0.001）。JHH/JHBMC 的 BPA 接受率从干预前的 7.8%增加到 31.3%（ < 0.0001）。在 HCGH，干预导致每次住院的遥测持续时间平均每月减少 20.2 小时（95%CI：19.1-22.8 小时， < 0.0001）。
优化 EHR BPA 可在不显著增加临床医生警报负担的情况下减少不必要的遥测时间。本研究强调了根据具体情况调整 EHR 警报以提高效果和促进基于价值的护理的重要性。
