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Embedding the American Heart Association’s recommendations for addressing the use of nonintensive care unit cardiac telemetry in an electronic ordering system reduced telemetry use without affecting patient safety.
The hardwiring into the electronic ordering system of AHA’s guidelines were implemented in Christiana Healthcare System of Newark, Del., on March 18, 2013. An examination of cardiac telemetry orders and associated costs from Dec. 31, 2012, to Aug, 12, 2013, found a reduction in telemetry orders.
Following the implementation, there was an “immediate and sustained reduction in the mean weekly number of telemetry orders from 1,032.3 to 593.2 and the mean duration of telemetry fell from 57.8 to 30.9 hours (reductions of 43% and 47%, respectively).”
Reducing non-ICU telemetry use was a part of the March 2013 list of the Society of Hospital Medicine in the Choosing Wisely campaign.
Research results were published online Sept. 22 in JAMA Internal Medicine.
The estimated total daily cost to deliver telemetry was $53.44 per telemetry patient, the authors wrote. The mean daily cost for non-ICU cardiac telemetry decreased from $18,971 to $5,772. Hardwiring the guidelines into the electronic ordering system is estimated to save Christiana Healthcare System $4.8 million annually.
“Although overuse of cardiac telemetry in non-ICU settings is widely recognized, there is a paucity of literature outlining successful and safe strategies addressing this concern,” Dr. Robert Dressler of Christiana Healthcare and his colleagues wrote in JAMA Internal Medicine. “Our project led to a sustained 70% reduction in telemetry use without adversely affecting patient safety. In fact, patient safety may be enhanced by reducing the potential for alarm fatigue and provider workflow interruption.”
Researchers reported no conflicts of interest.
While results of the hardwiring of the American Heart Association’s guidelines on telemetry into an electronic ordering system to help reduce use in the nonintensive care setting shows promise, there needs to be a randomized trial gather the evidence needed to get this into general practice, according to Dr. Nadar Najafi.
The substantial reduction at Christiana Healthcare System suggests that telemetry is overused and the AHA guidelines can safely reduce unnecessary monitoring. Since the guidelines exclude patients who do not have a primary cardiac condition, the intervention safely reduced or eliminated monitoring these patients. “It is a reminder of the absence of known clinical benefit of using telemetry on medical and surgical services,” Dr. Najafi wrote in commentary published online Sept. 22 in JAMA Internal Medicine.
“We are entering an era of unprecedented technological advancement in medicine,” he continues. “Unfortunately, technology often overtakes scientific evidence in the race to the bedside. We must remain vigilant against this outcome in the name of patient safety and cost.”
Dr. Najafi works in the division of hospital medicine at the University of California, San Francisco.
While results of the hardwiring of the American Heart Association’s guidelines on telemetry into an electronic ordering system to help reduce use in the nonintensive care setting shows promise, there needs to be a randomized trial gather the evidence needed to get this into general practice, according to Dr. Nadar Najafi.
The substantial reduction at Christiana Healthcare System suggests that telemetry is overused and the AHA guidelines can safely reduce unnecessary monitoring. Since the guidelines exclude patients who do not have a primary cardiac condition, the intervention safely reduced or eliminated monitoring these patients. “It is a reminder of the absence of known clinical benefit of using telemetry on medical and surgical services,” Dr. Najafi wrote in commentary published online Sept. 22 in JAMA Internal Medicine.
“We are entering an era of unprecedented technological advancement in medicine,” he continues. “Unfortunately, technology often overtakes scientific evidence in the race to the bedside. We must remain vigilant against this outcome in the name of patient safety and cost.”
Dr. Najafi works in the division of hospital medicine at the University of California, San Francisco.
While results of the hardwiring of the American Heart Association’s guidelines on telemetry into an electronic ordering system to help reduce use in the nonintensive care setting shows promise, there needs to be a randomized trial gather the evidence needed to get this into general practice, according to Dr. Nadar Najafi.
The substantial reduction at Christiana Healthcare System suggests that telemetry is overused and the AHA guidelines can safely reduce unnecessary monitoring. Since the guidelines exclude patients who do not have a primary cardiac condition, the intervention safely reduced or eliminated monitoring these patients. “It is a reminder of the absence of known clinical benefit of using telemetry on medical and surgical services,” Dr. Najafi wrote in commentary published online Sept. 22 in JAMA Internal Medicine.
“We are entering an era of unprecedented technological advancement in medicine,” he continues. “Unfortunately, technology often overtakes scientific evidence in the race to the bedside. We must remain vigilant against this outcome in the name of patient safety and cost.”
Dr. Najafi works in the division of hospital medicine at the University of California, San Francisco.
Embedding the American Heart Association’s recommendations for addressing the use of nonintensive care unit cardiac telemetry in an electronic ordering system reduced telemetry use without affecting patient safety.
The hardwiring into the electronic ordering system of AHA’s guidelines were implemented in Christiana Healthcare System of Newark, Del., on March 18, 2013. An examination of cardiac telemetry orders and associated costs from Dec. 31, 2012, to Aug, 12, 2013, found a reduction in telemetry orders.
Following the implementation, there was an “immediate and sustained reduction in the mean weekly number of telemetry orders from 1,032.3 to 593.2 and the mean duration of telemetry fell from 57.8 to 30.9 hours (reductions of 43% and 47%, respectively).”
Reducing non-ICU telemetry use was a part of the March 2013 list of the Society of Hospital Medicine in the Choosing Wisely campaign.
Research results were published online Sept. 22 in JAMA Internal Medicine.
The estimated total daily cost to deliver telemetry was $53.44 per telemetry patient, the authors wrote. The mean daily cost for non-ICU cardiac telemetry decreased from $18,971 to $5,772. Hardwiring the guidelines into the electronic ordering system is estimated to save Christiana Healthcare System $4.8 million annually.
“Although overuse of cardiac telemetry in non-ICU settings is widely recognized, there is a paucity of literature outlining successful and safe strategies addressing this concern,” Dr. Robert Dressler of Christiana Healthcare and his colleagues wrote in JAMA Internal Medicine. “Our project led to a sustained 70% reduction in telemetry use without adversely affecting patient safety. In fact, patient safety may be enhanced by reducing the potential for alarm fatigue and provider workflow interruption.”
Researchers reported no conflicts of interest.
Embedding the American Heart Association’s recommendations for addressing the use of nonintensive care unit cardiac telemetry in an electronic ordering system reduced telemetry use without affecting patient safety.
The hardwiring into the electronic ordering system of AHA’s guidelines were implemented in Christiana Healthcare System of Newark, Del., on March 18, 2013. An examination of cardiac telemetry orders and associated costs from Dec. 31, 2012, to Aug, 12, 2013, found a reduction in telemetry orders.
Following the implementation, there was an “immediate and sustained reduction in the mean weekly number of telemetry orders from 1,032.3 to 593.2 and the mean duration of telemetry fell from 57.8 to 30.9 hours (reductions of 43% and 47%, respectively).”
Reducing non-ICU telemetry use was a part of the March 2013 list of the Society of Hospital Medicine in the Choosing Wisely campaign.
Research results were published online Sept. 22 in JAMA Internal Medicine.
The estimated total daily cost to deliver telemetry was $53.44 per telemetry patient, the authors wrote. The mean daily cost for non-ICU cardiac telemetry decreased from $18,971 to $5,772. Hardwiring the guidelines into the electronic ordering system is estimated to save Christiana Healthcare System $4.8 million annually.
“Although overuse of cardiac telemetry in non-ICU settings is widely recognized, there is a paucity of literature outlining successful and safe strategies addressing this concern,” Dr. Robert Dressler of Christiana Healthcare and his colleagues wrote in JAMA Internal Medicine. “Our project led to a sustained 70% reduction in telemetry use without adversely affecting patient safety. In fact, patient safety may be enhanced by reducing the potential for alarm fatigue and provider workflow interruption.”
Researchers reported no conflicts of interest.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Following AHA guidelines on non-ICU telemetry use reduced usage without adverse patient outcomes.
Major finding: Use of guidelines reduced mean weekly telemetry orders from 1,032.3 to 593.2 and mean duration fell from 57.8 hours to 30.9 hours.
Data source: A review of non-ICU telemetry orders in the Christiana Healthcare System from 2013.
Disclosures: Research was supported by the Delaware IDeA Networks of Biomedical Research Excellence, with grants from the National Institute of General Medical Sciences. No conflicts of interest were reported.