Targeted electronic health record reminder can reduce telemetry duration

1. In this study, a targeted electronic health record (EHR) reminder of telemetry-use beyond that recommended by guidelines resulted in the reduction of telemetry use on general medicine wards.

2. The most common physician response to the alert was discontinuation of telemetry, with no associated change in rapid-response calls.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The use of continuous cardiac monitoring through telemetry is indicated for monitoring for potentially lethal arrhythmias in certain conditions including after myocardial infarction. The use of telemetry in hospital is often overused when comparing to current guidelines. While previous multi-component interventions have been successful at reducing inappropriate telemetry use, the implementation has been limited due to resource intensity. The current trial sought to evaluate the effectiveness of an EHR reminder in reducing non-guideline-based telemetry for inpatients admitted to a general medicine ward. The study demonstrated a reduction in telemetry duration in-hospital with no increase in rapid response calls or medical emergency events.

The current study provides evidence for a small intervention that could lead to reduced hospital stay length, and avoidance of unnecessary testing to evaluate asymptomatic telemetry findings. The magnitude of effect is smaller than prior reports of multi-component interventions but it may be more generalizable. The strength of the study includes its cluster-randomized design of medical inpatients. The main limitations of the trial were the small sample size and inclusion of a single institution.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost

In-Depth [randomized controlled trial]: This study was conducted on the general medicine service at the University of California San Francisco (UCSF) Medical Center. The population included medical inpatients but excluded those admitted to the intensive care unit (ICU). House-staff and hospitalist teams were cluster-randomized to a control arm and an intervention arm with a clinical decision support alert when a patient’s telemetry order was longer than recommended per established guidelines when a physician was entering patient orders during the day.

The study included 1021 patients admitted to the 12 patient-care teams. The intervention arm had a reduction in telemetry duration by 8.7 hours per hospitalization (95%CI, −14.1 to −3.5 hours; P = .001). The most common physician action taken following display of the reminder was discontinuation of the telemetry (62%).

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