Are We Monitoring Too Much? A Critical Review of Telemetry Overuse in Inpatient Medicine

Continuous cardiac telemetry is a critical tool for detecting arrhythmias and guiding management in high-risk inpatients, but its diffusion into low-acuity settings has outpaced evidence of benefit. This review synthesizes contemporary evidence on the scope, consequences, and drivers of telemetry overuse, as well as strategies for aligning practice with guideline-based indications. Current data demonstrate that clinically significant arrhythmias are rarely detected in low-risk populations and that monitoring seldom alters management or improves outcomes. Instead, inappropriate use contributes to alarm fatigue, workflow interruptions, unnecessary diagnostic cascades, prolonged hospitalizations, and substantial health system costs. Overuse is driven by cultural norms of defensive medicine, educational gaps across provider groups, and systemic factors such as default order configurations, absent autoexpiration policies, and poor handoff communication. Quality improvement initiatives—including indication-based order entry, daily reassessment, nursing empowerment, and autodiscontinue timers—consistently reduce inappropriate telemetry without compromising patient safety. Emerging innovations, such as wearable monitors and artificial intelligence–enhanced alert algorithms, offer promising alternatives to improve monitoring precision and reduce alarm burden. Taken together, the evidence underscores the need for multifaceted interventions that integrate education, workflow redesign, and institutional leadership to ensure that telemetry use is both evidence-based and resource-conscious.