SHM Converge Scientific Abstract ePoster Gallery-Impact of a Multi-Disciplinary Intervention to Improve Guideline-Concordant Telemetry Use

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This study evaluated whether a clinical decision support (CDS) tool based on American Heart Association telemetry guidelines could reduce inappropriate telemetry use in a 10-hospital Midwestern health system.<br /><br />Telemetry is important but resource-intensive, and overuse can limit patient flow and worsen patient experience. The intervention condensed AHA guidance into categories and indications with recommended monitoring durations, embedded it in the electronic health record, and added an interruptive alert when the suggested duration ended. Researchers compared a 2-year pre-intervention baseline with 6 months after implementation using interrupted time series analysis.<br /><br />After implementation, telemetry use dropped quickly, and adherence to indication reporting improved to 90%. However, reductions in telemetry use did not lead to meaningful changes in length of stay, ICU transfer, 30-day readmission, or mortality. Patients on telemetry after implementation were older and had more comorbidities, but outcomes remained similar.<br /><br />The study also examined hypotensive episodes occurring off telemetry. These events increased after implementation, but there was no evidence of worse outcomes overall. In fact, adjusted 30-day mortality was lower for hypotensive episodes off telemetry, while readmission risk was higher later in the hospital stay. The authors concluded that telemetry for hypotensive patients does not appear to improve outcomes.<br /><br />Overall, the CDS intervention was effective in reducing telemetry overuse without harming hospital utilization or patient outcomes. The authors plan to further refine the tool, identify reasons for non-adherence, and consider alternative monitoring approaches such as continuous pulse-oximetry-based heart rate monitoring for high-risk patients without AHA indications.

Asset Subtitle

Brian Hilliard

Meta Tag

Author List April Sell, Brian Hilliard, Christopher Tignanelli, Debbie Pestka, Genevieve Melton-Meaux, Iva Ninkovic, James Grace, Joe Koopmeiners, Maya Peters, Michael Usher, Nathan Shippee, Nick Ingraham, Timothy Beebe

Category Research

Concept Continuous ECG Monitoring

Concept Telemetry Indication

Concept Clinical Decision Support

Concept Telemetry Utilization

Concept Hypotension

Distinguished Finalist

Presenter Organization University of Minnesota

Presenting Author Brian Hilliard

Track Quality Improvement

Keywords

clinical decision support

telemetry

American Heart Association guidelines

electronic health record

interruptive alert

inappropriate telemetry use

hospital utilization

hypotension

patient outcomes

interrupted time series analysis

Continuous ECG Monitoring

Telemetry Indication

Clinical Decision Support

Telemetry Utilization

Hypotension