Introduction
Telemetry is an important tool for real-time monitoring of patients in
the hospital. However, telemetry is expensive, contributes to alarm
fatigue, and may contribute to unnecessary diagnostics and
interventions.1-5 The first telemetry practice
standards were published nearly 30 years ago to guide appropriate use
outside of the intensive care unit (ICU).6 These
practice standards were updated in 2004 and again in 2017, complete with
specific telemetry durations by indication.7,8 Despite
these practice standards, telemetry is still frequently ordered
inappropriately and continued for excessively long
durations.9 Studies show that 57% of patients on
telemetry lack an American Heart Association (AHA) Class I or II
indication and the majority of providers remain unaware that these
practice standards exist.9-12
As part of the Choosing Wisely Campaign, the American Board of Internal
Medicine Foundation and the Society of Hospital Medicine have advocated
for the development of institution-based protocols for all non-intensive
care patients on telemetry to better incorporate evidence-based and
practice standard-driven telemetry practices.13However, most protocols implementing practice standard-based approaches
to improve telemetry appropriateness are labor-intensive or
ineffective.14-18 Data on successful interventions at
academic medical centers, where residents are the primary providers, are
particularly limited. Current literature predominantly uses stand-alone
educational interventions rather than system or workflow changes, and
thus the impact may not be sustained. Additionally, few studies have
examined the impact of nursing-driven initiatives to limit telemetry
use.19
We designed a study using systems-based interventions to reduce mean
time on telemetry among patients cared for by internal medicine
residents. We hypothesized that empowering nurses with the ability to
discontinue telemetry once the recommended indication-specific duration
had elapsed would lead to a reduction in mean time spent on telemetry.
Furthermore, we hypothesized that transitioning responsibility for
telemetry discontinuation from the nurse to the resident would lead to
an increase in patient time spent on telemetry.