Assessing Telemetry Utilization in Inpatient Care: Establishing and Evaluating the Impact of a Telemetry Admission Protocol

Cardiac telemetry monitoring is an essential tool for assessing cardiac function in hospitalized patients; however, its overuse in low-risk populations can increase healthcare costs, alarm fatigue, and unnecessary resource utilization. This study aimed to assess the use of cardiac telemetry at a tertiary care center in Puerto Rico. Using a retrospective cross-sectional review of medical records, we evaluated whether telemetry was used appropriately according to established clinical criteria and identified patterns of overuse. The findings provide a foundation for developing an institutional telemetry protocol to optimize telemetry utilization, enhance patient safety, and improve cost-effectiveness. A total of 822 hospitalized patients receiving cardiac telemetry were included. Variables such as history of cardiac disease, comorbidities, length of stay, indication for telemetry, and duration of monitoring were analyzed. Our findings revealed that 476 (57.9%) patients received telemetry for non-evidence-based reasons, while 346 (42.1%) had clear clinical indications. Patients with non-evidence-based telemetry had longer monitoring durations, averaging 5.68 ± 5.90 days compared to 2.98 ± 2.94 days for those with evidence-based indications. They also spent slightly less time in the emergency department, with a mean of 7.18 ± 4.73 hours, compared to 7.98 ± 6.44 hours for the evidence-based group. Although not statistically significant (p = 0.137), the mean length of stay was higher among non-evidence-based cases (6.73 ± 8.25 days) than among evidence-based cases (4.46 ± 7.38 days). These differences contributed to an estimated cost of $4,711 per patient for non-evidence-based telemetry compared to $3,122 per patient for evidence-based monitoring. This study suggests that implementing standardized, evidence-based guidelines for telemetry initiation and discontinuation could reduce overuse, lower costs, decrease alarm fatigue, and maintain patient safety while showcasing the potential benefits of a hospital-wide protocol to optimize telemetry practices.