S1378 Telemetry Monitoring in Upper Gastrointestinal Bleeding: A Resource Utilization Perspective

Introduction: The use of continuous electrocardiographic monitoring (telemetry) in the management of patients hospitalized for diagnosis of upper gastrointestinal bleed (UGIB) is a common practice that lacks substantial evidence. Given the higher requirement of human and financial resources associated with the use of telemetry, this study aimed to evaluate the true impact of telemetry on clinical outcomes of UGIB patients. Methods: We retrospectively reviewed a database of 340 patients admitted for UGIB to a safety net hospital in Kern County, CA, focusing on telemetry use and presence or absence of telemetry indications proposed by the American Heart Association (AHA). Primary outcome was 30-day mortality. Secondary outcomes were length of stay and rate of upgrade to a higher level of care (intensive care unit [ICU] or direct observational unit [DOU]). Results: Our analysis revealed no significant difference in mortality benefits or length of stay, and patients on telemetry did not experience an increased rate of upgrade to a higher level of care when compared to those without telemetry, when controlled for cardiac indications of telemetry. Conclusion: Judicious, evidence-based use of resources is key to a successful healthcare practice, particularly in the community setting. This study suggests that, in the absence of indications defined by the AHA, the use of telemetry is of no considerable benefit in patients hospitalized for UGIB in terms of mortality, length of stay and clinical escalation. A larger multicenter study is needed to better support these findings.