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.