| Peer-Reviewed

Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use

Received: 12 September 2019     Accepted: 4 October 2019     Published: 16 October 2019
Views:       Downloads:
Abstract

Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the intervention. The non-house-staff covered patients did not receive the intervention and served as the control group. The intervention included the implementation of American Heart Association cardiac monitoring guidelines, daily tele-census and indication evaluation, and discussion around telemetry status during multidisciplinary rounds. Data were collected from the pre- (90 day) and post intervention (90 day) periods for both groups. The intervention resulted in a 49% relative decrease in the average telemetry days in the intervention group (pre-intervention=5.7 days vs. post-intervention=2.9 days; p<0.001). The number of patients maintained on telemetry for >48 hours also decreased by 56% in the intervention group. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.

Published in American Journal of Internal Medicine (Volume 7, Issue 5)
DOI 10.11648/j.ajim.20190705.16
Page(s) 136-140
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Telemetry, Cardiac Monitoring, Quality Improvement

References
[1] Levinson, Wendy, et al. “‘Choosing Wisely’: a Growing International Campaign.” BMJ Quality & Safety. 2014; 24 (2): 167–174.
[2] Drew, BJ, et al; American Heart Association; Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation. 2004; 110 (17): 2721-2746.
[3] Sandhu, Kristin E., et al. “Update to Practice Standards for Electrographic Monitoring for Hospital Setting.” Circulation. 2017; 136 (3): 1-73.
[4] Najafi, Nader, and Andrew Auerbach. “Use and Outcomes of Telemetry Monitoring on a Medicine Service.” Archives of Internal Medicine. 2012; 172 (17): 1349.
[5] Patel, Sajan, et al. “Physicians Are Often Incorrect about the Telemetry Status of Their Patients.” The Journal of Hospital Medicine. 2017; 12 (1): 40–41.
[6] Snipelisky, David, et al. “Mayo Registry for Telemetry Efficacy in Arrest Study: An Assessment of the Utility of Telemetry in Predicting Clinical Decompensation.” Journal of Intensive Care Medicine. 2016; 33 (3): 166–175.
[7] Ramkumar, Satish, et al. “Guideline-Based Intervention to Reduce Telemetry Rates in a Large Tertiary Centre.” Internal Medicine Journal. 2017; 47 (7): 754–760.
[8] Dressler, Robert, et al. “Altering Overuse of Cardiac Telemetry in Non–Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines.” JAMA Internal Medicine. 2014; 174 (11): 1852.
[9] Svec, David, et al. “Hospitalist Intervention for Appropriate Use of Telemetry Reduces Length of Stay and Cost.” Journal of Hospital Medicine. 2015; 10 (9): 627–632.
[10] Lee JC, Lamb P, Rand E, Ryan C, Rubel B. Optimizing telemetry utilization in an academic medical center. J Clin Outcomes Manage. 2008; 15 (9): 435–440.
[11] Edholm, Karli, et al. “Decrease in Inpatient Telemetry Utilization through a System-Wide Electronic Health Record Change and a Multifaceted Hospitalist Intervention.” Journal of Hospital Medicine. 2017; 13 (8).
[12] Rizvi, Wajeeha, et al. “Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System.” Cureus. 2017; 5 (9).
[13] Silverstein N, Silverman A. Improving utilization of telemetry in a university hospital. J Clin Outcomes Manage. 2005; 12 (10): 519–522.
[14] Alsaad AA et al, A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry. Intern Med J. 2017 Jul; 47 (7): 754-760.
[15] Popova, Maria. “Autonomy, Mastery, Purpose: The Science of What Motivates Us, Animated.” Brain Pickings. Oct 2015. www.brainpickings.org/2013/05/09/daniel-pink-drive-rsa-motivation.
Cite This Article
  • APA Style

    Swapnil Patel, Mohammed Shariff, Jay Shah, Natasha Campbell, Shreya Gor, et al. (2019). Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use. American Journal of Internal Medicine, 7(5), 136-140. https://doi.org/10.11648/j.ajim.20190705.16

    Copy | Download

    ACS Style

    Swapnil Patel; Mohammed Shariff; Jay Shah; Natasha Campbell; Shreya Gor, et al. Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use. Am. J. Intern. Med. 2019, 7(5), 136-140. doi: 10.11648/j.ajim.20190705.16

    Copy | Download

    AMA Style

    Swapnil Patel, Mohammed Shariff, Jay Shah, Natasha Campbell, Shreya Gor, et al. Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use. Am J Intern Med. 2019;7(5):136-140. doi: 10.11648/j.ajim.20190705.16

    Copy | Download

  • @article{10.11648/j.ajim.20190705.16,
      author = {Swapnil Patel and Mohammed Shariff and Jay Shah and Natasha Campbell and Shreya Gor and Anas Alrefaee and Ijaz Khan and Arman Mushtaq and Mohamed Bakr and Christian Kaunzinger and Michael Carson and Elliot Frank and Mohammad Amir Hossain and Kim Carpenter and David Kountz and Kenneth Sable and Tushar Vachharajani and Arif Asif and Adam Kaplan},
      title = {Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use},
      journal = {American Journal of Internal Medicine},
      volume = {7},
      number = {5},
      pages = {136-140},
      doi = {10.11648/j.ajim.20190705.16},
      url = {https://doi.org/10.11648/j.ajim.20190705.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190705.16},
      abstract = {Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the intervention. The non-house-staff covered patients did not receive the intervention and served as the control group. The intervention included the implementation of American Heart Association cardiac monitoring guidelines, daily tele-census and indication evaluation, and discussion around telemetry status during multidisciplinary rounds. Data were collected from the pre- (90 day) and post intervention (90 day) periods for both groups. The intervention resulted in a 49% relative decrease in the average telemetry days in the intervention group (pre-intervention=5.7 days vs. post-intervention=2.9 days; p48 hours also decreased by 56% in the intervention group. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.},
     year = {2019}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use
    AU  - Swapnil Patel
    AU  - Mohammed Shariff
    AU  - Jay Shah
    AU  - Natasha Campbell
    AU  - Shreya Gor
    AU  - Anas Alrefaee
    AU  - Ijaz Khan
    AU  - Arman Mushtaq
    AU  - Mohamed Bakr
    AU  - Christian Kaunzinger
    AU  - Michael Carson
    AU  - Elliot Frank
    AU  - Mohammad Amir Hossain
    AU  - Kim Carpenter
    AU  - David Kountz
    AU  - Kenneth Sable
    AU  - Tushar Vachharajani
    AU  - Arif Asif
    AU  - Adam Kaplan
    Y1  - 2019/10/16
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajim.20190705.16
    DO  - 10.11648/j.ajim.20190705.16
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 136
    EP  - 140
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20190705.16
    AB  - Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the intervention. The non-house-staff covered patients did not receive the intervention and served as the control group. The intervention included the implementation of American Heart Association cardiac monitoring guidelines, daily tele-census and indication evaluation, and discussion around telemetry status during multidisciplinary rounds. Data were collected from the pre- (90 day) and post intervention (90 day) periods for both groups. The intervention resulted in a 49% relative decrease in the average telemetry days in the intervention group (pre-intervention=5.7 days vs. post-intervention=2.9 days; p48 hours also decreased by 56% in the intervention group. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.
    VL  - 7
    IS  - 5
    ER  - 

    Copy | Download

Author Information
  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Quality and Performance Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Quality and Performance Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Quality and Performance Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Department of Medicine and Hospital Medicine, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, USA

  • Sections