Implementing AHA guidelines with EMR intervention reduces unnecessary cardiac monitoring

A decision support intervention resulted in discontinuations of cardiac monitoring in line with American Heart Association guidelines, according to findings presented at the Society of Hospital Medicine Annual Meeting.

"Cardiac monitoring is often overused, hindering patient mobility, triggering unnecessary cardiac testing, delaying appropriate discharge and expending resources," Charles E. Coffey, Jr., MD, MSc, and colleagues wrote in an abstract.

"At Cedars-Sinai, only 59% of patients on [cardiac monitoring] had an AHA-approved indication for [cardiac monitoring]. Physicians were able to order [cardiac monitoring] without specifying an indication or stop date, and could keep patients on [cardiac monitoring] indefinitely. Prior efforts to reduce unnecessary [cardiac monitoring] use, including academic detailing, had not been effective.”

The researchers used the hospital's electronic medical record to implement the AHA guidelines throughout the hospital. In doing so, physicians had to prescribe cardiac monitoring by selecting a clinical indication, which had an associated length of time. Physicians and nurses received alerts before time expired, allowing them to discontinue cardiac monitoring, continue or defer to another care provider.

Data showed that physicians received 403 alerts from 143 patients and nurses received 1,657 alerts from 185 patients. Coffey and colleagues found that none of the alerts resulted in a nurse or physician continuing cardiac monitoring.

Cardiac monitoring was time-limited on 129 out of 331 patients (40%), the researchers stated. None of the nurses or physicians involved reported concerns regarding patient safety or time spent responding to the alerts.

"Based on data obtained to date, using a clinical decision support intervention to implement the AHA guidelines on [cardiac monitoring] has been acceptable to physicians and nurses, and has triggered clinically appropriate discontinuations of [cardiac monitoring], in accordance with the 2004 AHA guidelines," Coffey and colleagues concluded.

They reported that data collection is ongoing, including information on reasons for cardiac monitoring, time spent and numbers of patients on cardiac monitoring and the safety in limiting cardiac monitoring. – by Chelsea Frajerman Pardes

Disclosures: Healio Internal Medicine could not confirm relevant financial disclosures at the time of publication.

Reference:

Coffey CE Jr., et al. Abstract 362. Presented at: Society for Hospital Medicine Annual Meeting; March 6-9, 2016; San Diego.