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Implementing AHA guidelines reduced non-ICU telemetry use, saved costs
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Redesigning a cardiac telemetry ordering system according to American Heart Association guidelines decreased non-ICU telemetry use by 70% and saved substantial costs, according to research published in JAMA Internal Medicine.
Although the AHA telemetry guidelines have existed since 2004, it has been difficult for institutions to adapt them in a way that is not labor-intensive and that sustains decreases in use, Robert Dressler, MD, MBA, and colleagues from the Christiana Care Health System, Newark, Del., wrote.
In 2012, Christiana Care convened a team to increase the appropriate use of non-ICU cardiac telemetry by integrating the AHA guidelines into its electronic ordering system.
Dressler, vice chair of the department of medicine at Christiana Care, and colleagues noted that cardiac telemetry orders were removed from order sets for clinical conditions for which monitoring conditions were not supported by AHA guidelines, and remaining orders required physicians to select from a list of clinical indications, each with their corresponding guideline-directed telemetry durations.
The electronic ordering system included bedside nurse-assessment guidelines to facilitate discontinuation of cardiac telemetry, but it could be reordered when appropriate, according to the researchers.
During the study period from Dec. 31, 2012, to Aug. 12, 2013, weekly telemetry orders decreased 43%, from a mean of 1,032.3 to a mean of 593.2. In addition, mean telemetry duration decreased 47%, from 57.8 hours to 30.9 hours (P<.001 for both).
The mean daily number of patients monitored with telemetry declined 70%, from 357.2 to 109.1, Dressler and colleagues wrote.
Patient safety was not adversely affected as a result of the change: Hospital census, code blue, mortality and rapid response team activation rates were constant throughout the study period, according to the researchers.
The estimated mean daily cost of non-ICU cardiac telemetry decreased from $18,971 to $5,772, and the researchers estimated that the institution would save $4.8 million annually as a result.
“It is remarkable to achieve such a substantial reduction in the use of this resource without significantly increased adverse outcomes,” Nader Najafi, MD, from the division of hospital medicine at University of California, San Francisco, wrote in an invited commentary.
“This result suggests two conclusions. First, telemetry is overused, and the AHA guidelines, imperfect as they may be, can safely rein in unnecessary monitoring. Second, since the guidelines exclude patients who do not have a primary cardiac condition, the intervention must have safely reduced or nearly eliminated monitoring for these patients. It is a reminder of the absence of known clinical benefit of using telemetry on medical and surgical services. To practice evidence-based care, we need a randomized trial of telemetry,” Najafi wrote.
For its cardiac telemetry initiative, Christiana Care won the Ninth Annual Health Devices Achievement Award from ECRI Institute for facilitating better strategic management of health technology.
For more information:
Dressler R. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.4491.
Najafi N. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.3502.
Disclosure: The study was supported in part by a grant from the NIH. The researchers and Najafi report no relevant financial disclosures.