Abstract 126: Putting Into Practice: American Heart Association 2017 Standards for Hospital Electrocardiographic Monitoring and Inappropriate Telemetry Use
Authors: Garcia Raul Angel , Garg Delyse , Nielson Rosemarie , Lourdusamy Dennis , Vasudev Rahul , Pullatt Raja 
Published: April 2019

Background:
Initially hospital electrocardiographic monitoring (telemetry) was introduced for heart rate and rhythm monitoring in the CCU. It has expanded, but with the caveat of increased inappropriate use. In one study
1
of 236 admissions, 50% of the 745 monitoring days were not indicated by ACC/AHA guidelines. Similar studies
2
have been done, but these were done prior to the release of the 2017 AHA Updates on the Standards of Inpatient Electrocardiographic monitoring
3
. Our intent was to evaluate the power of education alone, and the ability thus to implement recent expert recommendations into current practice.

Methods:
A retrospective evaluation was done (chart review over 3 months) for patients admitted to telemetry units to then assess the appropriateness of telemetry usage. Intervention was through the education on the appropriate indications and duration of inpatient telemetry as per the “Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings
3
.” Education included providing the guidelines and indications to physicians/medical staff. After intervention, charts were reviewed over the next 3 months to evaluate for changes. The study was created as a cyclical/rolling study.

Results:
Out of the 166 charts reviewed from the pre intervention group, 61 involved patients on telemetry, and 14/61 (23%) was the percentage of inappropriate telemetry usage. In the post-intervention group, 248 charts reviewed, 94 involved patients on telemetry, and inappropriate telemetry usage was 14/94 (15%). The most common reasons for inappropriate telemetry use: hemodynamically stable GI bleed (6/28), alcohol withdrawal (4/28), and hypertensive urgency (6/28). Between the two groups there was an 8% decrease, showing more appropriate use of telemetry after intervention (statistical significance, p-value=0.2). Bed allocation however specifically improved along with several other end-points.

Conclusion:
The 8% decrease in the inappropriate telemetry usage created better bed allocation from the emergency department (ED) and led to decreased ED wait times and earlier transfers of patients from the intensive care unit. The overall results were in accordance with our expectations as we were aware of the limitations (length of study time, single intervention of education). However, the sole education of the AHA 2017 standards
3
led to desired trends of decreased in inappropriate telemetry use and opening several avenues to augment patient care and placement, liberation of multiple medical departments to deliver more focused care, and overall improvement in hospital work flow and cost-effectiveness. With interdepartmental efforts, use of technology, protocols and more, the current practices will become all the more likely to mirror the recommended standards. We thus plan to continue to move on to the further stages of our model to reveal the summative endpoints achieved.