Appropriate Application of Cardiac Telemetry Monitoring: A Quality Improvement Initiative

Background: Telemetry is an important clinical tool but it can be overutilized and leads to a higher cost of patient care and negative patient experience. We conducted this study to assess the effectiveness of our educational intervention in reducing inappropriate use of telemetry and to determine if there is any difference between the two types of educational interventions. Methods: We conducted a retrospective in-patient study that included all non-ICU patients admitted on a randomly selected mid-week day at our hospital. A 2-step educational intervention was used separated by a 5-week period. The first, a PowerPoint presentation regarding the updated 2017 AHA telemetry guidelines that was presented at an educational conference. Second, pocket cards with QR codes were provided which showed a concise tabular form of appropriate indications for telemetry monitoring according to the AHA. Study materials used in both interventions were also provided for E-learning and self-study. Twice weekly reminders and refresher sessions were arranged for the provider teams during the study period. The same process and protocol were repeated after intervals of 5 weeks to collect post-intervention datasets 1 and 2. Results: Appropriate telemetry usage increased from 33.6% to 51.7% after intervention 1 and 62.5% after intervention 2. There was no difference in the efficacy between the two educational interventions used in the study. The number of telemetry days decreased from 7.8 days to 6.6 days after intervention 1 and 6.2 days after intervention 2. There was no significant difference in the length of hospital stay between pre-intervention and post-intervention 1 and 2 (5.8 vs 6.7 vs 5.6 days respectively). Conclusion: Educational intervention has a positive impact on reducing the inappropriate use of telemetry, and it is irrespective of the type of intervention (one time PowerPoint presentation vs educational materials with regular reminders) as long as it can be incorporated into the medical system.