Inappropriate use of telemetry frequently occurs in the inpatient,
non-intensive care unit setting. Recent telemetry practice standards
have attempted to guide appropriate use and limit the overuse of this
important resource, with limited success. Clinical-effectiveness studies
of these practice standards have thus far not included care settings in
which resident-physicians are the primary caregivers. Furthermore,
studies of the role of nurses in appropriate telemetry use are lacking.
In this report, we describe two interventions implemented on general
internal medicine units of a large academic hospital over three years.
The first intervention, or nurse-discontinuation protocol, allowed
nurses to trigger the discontinuation of telemetry once the appropriate
duration had passed according to practice standards. The second
intervention, or physician-discontinuation protocol, instituted a Best
Practice Advisory that notified the resident-physician via the
electronic medical record when the appropriate telemetry duration for
each patient had elapsed and suggested termination of telemetry. Results
showed that the nurse-discontinuation protocol reduced mean patient time
on telemetry and the physician-discontinuation protocol reduced mean
telemetry orders per patient. These findings validate a prior study and
expand on our understanding of telemetry use in the academic care
setting in which trainees serve as the primary caregivers.