Key result
Cardiac telemetry protocol linked to ~10-point reduction in telemetry use without increasing mortality.
Why the study?
Using cardiac telemetry without clinical indications generates unnecessary alarms, increasing alarm fatigue and healthcare costs. This study sought to reduce alarm fatigue and costs associated with cardiac telemetry monitoring through a multidisciplinary protocol and education.
Observational
No
Answers are grounded in this paper and cite their sources.
May support telemetry stewardship to cut costs; leaves open whether randomized trials confirm safety.
BACKGROUND: Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring. METHODS: After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants. RESULTS: At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%. CONCLUSION: All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
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Alsaad et al. (2017) conducted an observational in Cardiac telemetry monitoring and alarm fatigue. New protocol for cardiac telemetry placement and staff education vs. Pre-intervention baseline (13 weeks prior to protocol implementation) was evaluated on Cardiac telemetry usage assignment (ARR 10%, p=<0.001). Implementing a cardiac telemetry protocol and staff education reduced telemetry usage from 77% to 67% (p<0.001) and lowered cost by 42% without increasing mortality (p>0.05).
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