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Off-site central monitoring applying standardized cardiac telemetry safe, effective
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In a new study, use of off-site central monitoring of non-critically ill patients with standardized cardiac telemetry indications was associated with prompt response to heart rhythm and rate changes and no compromise in safety.
“Normal hospital activities occurring at the nursing station might potentially distract on-site personnel from continuous vigilant patient monitoring, in addition to the possibility of vigilance being divided by other on-site duties,” Daniel Cantillon, MD, FACC, FHRS, staff physician of the section of cardiac electrophysiology and medical director of Central Monitoring Unit at Cleveland Clinic and colleagues wrote. “Off-site monitoring allows dedicated personnel to provide patient monitoring removed from the hospital wards with centralized staffing and standardized practices.”
Daniel Cantillon
According to Cantillon and colleagues, electronic telemetry orders for standard indications such as tachyarrhythmias and bradyarrhythmias were placed for 99,048 patients: 72,199 at Cleveland Clinic’s main campus and 26,849 at the three regional hospitals. About 16% of the indications for cardiac telemetry were for atrial or ventricular tachyarrhythmias.
During a 13-month observation period, the removal of low-risk patients based on the standardized criteria reduced the monitored patient census by 15.5% compared with the prior 13-month period (580 vs. 670 patients; P < .001).
Overall, 3,243 emergency response team activations occurred among monitored patients and 979 (30%) had a detectable rhythm or rate change within 1 hour before the emergency response team was deployed. Proper detection and notification was given by the central monitoring unit for 772 of the 979 patients (79%). Among the remaining patients, 176 were classified as having a missed event, 16 were classified as simultaneous alarm events with emergency response team activation and 15 were classified as process failures.
Cantillon and colleagues reported a 93% survival rate of cardiopulmonary arrests among 27 patients for whom the central monitoring unit gave advance warnings. There were 126 cardiopulmonary arrests in the 13 months before the launch of the central monitoring system and 122 in the 13 months after.
“These data demonstrate that integrating a [central monitoring unit] and an [emergency response team] is feasible, which is particularly important for hospital systems with dedicated emergency response teams in which operational and capital costs permit scalability,” the researchers wrote. “Once the required resources are in place, the [central monitoring unit] can extend its operability to hospitals that are widely geographically separated while interfacing directly with site-specific [emergency response teams]. Future work and technological innovations are needed to further improve efficiency and reduce costs.” – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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