Off-site central monitoring of cardiac telemetry effective for non-critical patients

1. In this descriptive account of a standardized, off-site central monitoring unit, the number of orders for inpatient cardiac telemetry decreased by 15%.

2. Roughly 80% of rhythm and rate changes were communicated to the emergency response team within 1 hour of detection.

Evidence Rating Level: 3 (Average)

Study Rundown: In non-intensive care units, cardiac telemetry generates non-clinically relevant alarms in over 90% of cases, prompting The Joint Commission to require effective alarm management policies by 2016. The use of off-site, central monitoring units (CMUs) with standardized protocols for patient selection and cardiac telemetry has been suggested as a more effective alternative to current practices. In March of 2014, the Cleveland Clinic created institutionally standardized indications for cardiac telemetry in non-critically ill patients and a CMU to monitor suspicious cardiac activity at its main campus and three regional hospitals. This articles reports on the program after 13 months of operation. During this time, there was a 15% reduction in weekly cardiac telemetry use. Among all cardiac telemetry notifications, 52% were for non-arrhythmic and non-hemodynamic reasons, mostly for lead failure. In addition, the CMU correctly notified the inpatient emergency response teams (ERTs) of suspicious cardiac events in 80% of cases.

Though the results of this study are difficult to assess without a control group, a prominent 5-year observational study reported that only 56% of patients with cardiac arrest were identified by traditional on-site monitoring units without standardized telemetry practices. While a more controlled comparison is likely warranted, it is likely that this approach to cardiac telemetry will be cost-effective and more efficient in non-intensive care unit settings.

Click to read the study in JAMA

Relevant Reading: Altering Overuse of Cardiac Telemetry in Non–Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines

In-Depth [cross-sectional study]: Over a 13 month period, there were 99 048 patients monitored remotely by a CMU at the Cleveland Clinic’s main campus and three regional hospitals. Standardized guidelines for monitoring were created using the 2004 American Heart Association recommendations and perceived health system needs. Over the duration of the study there was a significant 15.5% reduction in the number of patients monitored on the hospital floor (p < 0.001) and 410 534 notifications were generated across the four locations. In all, 52% of these notifications were for non-arrhythmic/non-hemodynamic events, of which 80% were due to lead failure. The CMU detected and provided accurate notification of suspicious cardiac activity to the ERT in 79% of cases. There were 105 cases where the CMU directly contacted the ERT due to severe cardiac events—27 (26%) for cardiopulmonary arrest—of which 93% resulted in resuscitation of spontaneous circulation. There were 7 cardiopulmonary arrest events during which the CMU was unable to notify a bedside nurse, however, escalating the response to a head nurse was effective in cases.

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