Inappropriate Telemetry Use Is Increased during the COVID-19 Era.

Jean Kim,Yoshito Nishimura,Ryan Honda,Kyle Miyazaki

doi:10.3390/healthcare9121610

Abstract

Due to the unprecedented COVID-19 pandemic, there may be overuse of telemetry monitoring compared to the pre-pandemic period. We compared the frequency of inappropriate telemetry use in the pre-COVID-19 period (1 November 2019 to 28 February 2020) versus the peri-COVID-19 period (1 March 2020 to 30 June 2020) at a major academic hospital in Honolulu, Hawaii, by a retrospective chart review to assess for the appropriateness of the telemetry orders during this period, based on the 2017 American College of Cardiology/American Heart Association guidelines. Compared to the pre-COVID-19 period, there was a significant increase in inappropriate telemetry use during the peri-COVID-19 period (X2 (1, N = 11,727) = 6.59, p = 0.0103). However, there was no increase in the proportions of respiratory failure (4.0%) or pneumonia (2.7%) during the peri-COVID-19 period. The increase in inappropriate telemetry use may be related to the uncertainty in clinical care and decision making amid the pandemic of the new virus. Appropriate utilization of telemetry monitoring is increasingly important during the pandemic due to the limited availability of resources. Further investigation is needed to clarify the relationship between the pandemic and trends in telemetry ordering.

Highlights

The electrocardiogram (ECG) was invented more than 100 years ago, the concept of continuous cardiac monitoring was not available until the early 1960s [1]
The telemetry orders were assessed for their appropriateness in accordance with the 2017 American College of Cardiology (ACC)/American Heart Association (AHA)
Table summarizes the information about telemetry ordering, including reasons for1 inappropriate telemetry orders in the pre-COVID

Summary

Introduction

The electrocardiogram (ECG) was invented more than 100 years ago, the concept of continuous cardiac monitoring was not available until the early 1960s [1]. Telemetry is a frequently utilized and essential modality of cardiac monitoring in acute hospitalization settings for rhythm surveillance and diagnosis of arrhythmias. It can be associated with high costs and the utilization of resources [2]. In order to guide its appropriate use, practice guidelines were implemented in 2004 with an update in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) [3]. The use of telemetry remains widespread; studies have demonstrated that as many as 43% of monitored patients continue to receive telemetric monitoring despite a lack of appropriate indications [4]. Familiarizing oneself with telemetry indications and interpreting telemetry data is crucial for physicians both from a clinical as well as a high-value care standpoint

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Results

Conclusion