Abstract
Guidelines for continuous cardiac monitoring (CCM) have focused almost exclusively on cardiac diagnoses, thus limiting their application to a general medical population. In this study, a retrospective chart review was performed to identify the reasons that general medical patients, cared for on hospitalist-led inpatient teaching teams between April 2017 and February 2018, were initiated and maintained on CCM, and to determine the incidence of clinically significant arrhythmias in this patient population. The three most common reasons for telemetry initiation were sepsis (24%), arrhythmias (12%), and hypoxia (10%). Most patients remained on telemetry for more than 48 hours (62%) and a significant number of patients were on telemetry until they were discharged from the hospital (39%). Of the cumulative total of more than 20,573 hours of CCM provided to this patient population, 37% of patients demonstrated only normal sinus rhythm and 3% had a clinically significant arrhythmia that affected management.
Highlights
Telemetry was introduced in hospitals during the 1960s to provide continuous cardiac monitoring (CCM) in cardiac intensive care units (ICUs)
One thousand five hundred ninety-four patients were admitted to a hospitalist-led internal medicine (IM) residentstaffed inpatient teaching team under a level of care (LOC) of "general floor" without telemetry between April 2017 and February 2018
Two hundred ninety-six patients were subsequently initiated on CCM during their hospital course with a change in LOC to "telemetry." Forty-two patients were excluded with a resultant study population of 254 patients
Summary
Telemetry was introduced in hospitals during the 1960s to provide continuous cardiac monitoring (CCM) in cardiac intensive care units (ICUs). Concurrent with the broad application of cardiac monitoring, the American Heart Association (AHA) and American College of Cardiology (ACC) have published guidelines for the appropriate use of non-ICU electrocardiographic (ECG) monitoring based on a consensus opinion [1,2]. The inappropriate use of telemetry monitoring can negatively affect patients, providers, and the hospital organization. Given the cost of equipment, maintenance, and supplies, including batteries, paper, and monitor leads. It is laborintensive; nurses spend an average of about 20 minutes per patient per day on telemetryrelated tasks [6].
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