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Targeted EHR alert safely, successfully reduces telemetry

An electronic health record alert sent out at a specific time and to specific medical professionals safely and successfully lowered cardiac monitoring, according to findings recently published in JAMA Internal Medicine.

“Despite American Heart Association indication–specific best practice standards, telemetry is overused, both in initiation and in duration of monitoring. This results in excess cost and ‘alarm fatigue,’ a phenomenon of desensitization to alarms when they are frequently false or irrelevant,” Nader Najafi, MD, of the department of medicine at the University of California, San Francisco and colleagues wrote. “The American Board of Internal Medicine Foundation recommends a protocol to promote early telemetry discontinuation.”

Six randomly chosen inpatient teams received an alert during daytime hours when physicians tried to place an order for non-ICU patients whose telemetry order duration extended beyond the recommended duration for a particular condition. Another six teams did not get the alert. Researchers used 1,066 hospitalizations for their analysis.

Najafi and colleagues found that the alert led to a significant reduction in telemetry monitoring duration (8.7 hours per hospitalization; 95% CI, 14.1 to 3.5 hours). There was no concomitant educational or audit and feedback campaign, no human resources dedicated to monitoring telemetry use, and no increase in adverse events as measured by rapid-response or medical emergency activation. The most common physician response to the alert was to stop telemetry monitoring.

“The present study extends the prior studies in important ways. First, we demonstrate that an EHR alert targeted to the right clinicians (primary team physicians), at the right time (daylight hours, while the physician is writing orders), with the right clinical context (telemetry exceeds recommended duration) can succeed without an associated educational or audit and feedback campaign. Second, we demonstrated this in a randomized trial that minimized the effects of secular trends or unmeasured confounders,” Najafi and colleagues wrote.

“Finally, we were able to demonstrate that when physicians were shown these targeted alerts, their majority behavior was to act in a practice standard-concordant way,” they added. – by Janel Miller

Disclosure s : Najajfi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.