Simple intervention cut monitoring time by 17% in randomized trial
Electronic health record (EHR) alerts when a telemetry order exceeds the recommended duration contributed to a safe decline in cardiac monitoring in a cluster-randomized clinical trial.
The EHR notification cut telemetry monitoring by 8.7 hours per hospitalization compared with no notification (P=0.001), and there wasn't a significant variation in emergency calls (6.0% vs 5.6%, P=0.90) or urgent medical events between groups, reported Nader Najafi, MD, of the University of California San Francisco, and colleagues in JAMA Internal Medicine.
The effect on telemetry duration was "notably smaller" than seen in other multicomponent quality improvement interventions, Najafi's group wrote.
However, it "was achieved without a concomitant educational or audit and feedback campaign, without human resources dedicated to monitoring telemetry use, and without an increase in adverse events as measured by rapid-response or medical emergency activation," they noted, so it would be "less costly and more scalable."
The study assessed 1,021 patients. The intervention group had a mean age of 64.5 and were 45% women, while the control group had a mean age of 63.8 and were 46% women.
The 12 general medicine service health teams, four of which were hospitalist teams and eight of which were house-staff teams, were cluster randomized at the team level to get or not get pop-up alerts on their computer screen during order entry in daytime hours when a patient had an active telemetry order outside the ICU that didn't meet the American Heart Association indication-specific best practice standards (with a few local tweaks).
When physicians received a telemetry notification, they decided to stop telemetry monitoring 62% of the time, 7% of the time they disregarded the notification, 21% of the time they requested telemetry again, and 11% of the time physicians responded to the alert but continued with the current course, the investigators found.
The mean telemetry hours per hospitalization were 41.3 with the intervention versus 50.0 among controls, a reduction of 17%.
The investigators acknowledged the limitations of their work: The results might not generalize to other locations, as the study is based on a single medical facility. And, the suggestions for telemetry hours were partially based on local expert outlook, making them more lenient than national practice guidelines.
"Finally, the preintervention mean telemetry hours at the UCSF Medical Center general medicine service was already lower than the baseline in prior studies,which may have limited the effect size of this intervention," the researchers wrote.