Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health Record Change and a Multifaceted Hospitalist Intervention
BACKGROUND: Unnecessary telemetry monitoring contributes to healthcare waste.
OBJECTIVE: To evaluate the impact of 2 interventions to reduce telemetry utilization.
DESIGN, SETTING, AND PATIENTS: A 2-group retrospective, observational pre- to postintervention study of 35,871 nonintensive care unit (ICU) patients admitted to 1 academic medical center.
INTERVENTION: On the hospitalist service, we implemented a telemetry reduction intervention including education, process change, routine feedback, and a financial incentive between January 2015 and June 2015. In July 2015, a system-wide change to the telemetry ordering process was introduced.
MEASUREMENTS: The primary outcome was telemetry utilization, measured as the percentage of daily room charges for telemetry. Secondary outcomes were mortality, escalation of care, code event rate, and appropriateness of telemetry utilization. Generalized linear models were used to evaluate changes in outcomes while adjusting for patient factors.
RESULTS: Among hospitalist service patients, telemetry utilization was reduced by 69% (95% confidence interval [CI], −72% to −64%; P < .001), whereas on other services the reduction was a less marked 22% (95% CI, −27% to −16%; P < .001). There were no significant increases in mortality, code event rates, or care escalation, and there was a trend toward improved utilization appropriateness.
CONCLUSION: Although electronic telemetry ordering changes can produce decreases in hospital-wide telemetry monitoring, a multifaceted intervention may lead to an even larger decline in utilization rates. Whether these changes are durable cannot be ascertained from our study.
© 2018 Society of Hospital Medicine
CONCLUSION
In this single-site study, combining EHR orders prompting physicians to choose a clinical indication and duration for monitoring with a broader program—including upstream changes in ordering as well as education, audit, and feedback—produced reductions in telemetry usage. Whether this reduction improves the appropriateness of telemetry utilization or reduces other effects of telemetry (eg, alert fatigue, calls for benign arrhythmias) cannot be discerned from our study. However, our results support the idea that multipronged approaches to telemetry use are most likely to produce improvements.
Acknowledgments
The authors thank Dr. Frank Thomas for his assistance with process engineering and Mr. Andrew Wood for his routine provision of data. The statistical analysis was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764).
Disclosure
The authors have no conflicts of interest to report.
