PURPOSE: Due to the lack of a formal process for patients on telemetry in our institution we had a persistent deficit of telemetry pack availability. In our quest to improve our processes between patient flow, physician/patient needs and the finite number of telemetry packs we instituted a diagnosis specific, time limited, process for discontinuation of telemetry at 48 hours.
METHODS: A clinical collaboration of physicians, administrators, and nurses researched the use of automatic telemetry discontinuation policies in other institutions nationally and locally; reviewed evidenced based literature for indications regarding telemetry monitoring; and reviewed our own telemetry policies, procedures, and current practice. From this review we developed a telemetry order form based upon specified diagnoses: a.“Acute Telemetry” - without a time limit; b.“Telemetry” - time limited at 48 hours with option for renewal; c.“Other” - for diagnoses not listed in the aforementioned categories. To renew telemetry at 48 hours a new form had to be completed. We instituted this process hospital wide at the end of “Heart Month,” February 2011.
RESULTS: Our intervention to improve availability of telemetry packs resulted in a significant decrease in telemetry usage each shift by 7.1% from 60.7 +10.9 (n =1,110 shifts) to 56.4 +12.5 (n=91 shifts, p = 0.002). We compared the average telemetry pack usage pre and post protocol between 1/1/2010 to 4/23/2011.
CONCLUSIONS: Our new process of a diagnosis specific, time limited telemetry order form along with clinical evaluation of the patient at the end of 48 hours has enabled a better balance between provider/patient need and availability of telemetry packs. This has lessened the need by the clinical staff to spend time and energy to “free up telemetry packs right now,” since telemetry packs are more readily available.
CLINICAL IMPLICATIONS: This is a relatively easy intervention that can be replicated in any hospital with support from all disciplines. We believe that this will eliminate one impediment that negatively impacts Emergency Department throughput.
DISCLOSURE: The following authors have nothing to disclose: Mickey Lebowitz, Rob Pikarsky, Lynne Shopiro, Jim Longo, Russell Acevedo
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