Abstract Body (Do not enter title and authors here): Background
The American Heart Association (AHA) provides telemetry guidelines for hospitalized patients. However, 43% of telemetry orders lack an AHA-recommended indication. Telemetry use beyond the guidelines leads to unnecessary testing, increased lengths of stay, and increased healthcare cost. Using the FOCUS-PDSA framework, we aimed to significantly decrease both inappropriate telemetry orders and expired telemetry patient-days.
Methods
Pre-intervention data were obtained via retrospective study of telemetry monitoring data on three 16-bed medical/surgical units at Jennie Sealy Hospital in December 2023. We classified telemetry orders as appropriate or inappropriate and subsequently modified the EPIC telemetry order set, requiring selection of AHA indication. A best practice advisory was also created to prompt renewal or discontinuation of expired orders. Post-intervention data was collected in July 2024. A chi-square test then compared the proportion of inappropriate telemetry orders and expired days pre- and post-intervention with a significance threshold of p<0.05.
Results
The pre-intervention dataset included 150 telemetry orders, with 43% placed under inappropriate indications. Of the 558 total telemetry patient-days, 151 were with expired telemetry orders (27%). In comparison, the post-intervention dataset included 128 telemetry orders, with 38% placed under inappropriate indications. Of the 253 total telemetry patient-days, 28 were with expired telemetry orders (11%). Overall, there were 15% fewer telemetry orders with a 55% decrease in telemetry patient-days. While the 12% reduction in inappropriate orders was not statistically significant, we significantly reduced expired telemetry days by 59% (p<0.001).
Conclusions
The implemented interventions encourage physicians to reconsider the necessity of telemetry for hospitalized patients, likely improving adherence to AHA guidelines. The significant reduction in expired telemetry patient-days demonstrates efficient management of telemetry monitoring, with an estimated $4,200.00 saved during the study period and a projected annual savings of over $50,000 based on prior cost analyses. Next PDSA cycle will include an educational component and continued optimization of our order set. Optimizing telemetry use in the inpatient setting enhances the ability of healthcare teams to detect critical arrhythmias and avoid unnecessary procedures, ultimately improving clinical efficiency and reducing healthcare costs.