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Overuse of continuous telemetry monitoring can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase costs. A nurse-driven protocol for discontinuing continuous telemetry without requiring consultation with the ordering provider effectively reduced institutional financial burden and reduced nurserelated telemetry tasks.
Healthcare costs in the United States are growing at an unsustainable rate. Approximately $1 in $3 is spent on wasted care, which would not affect quality negatively if omitted. Unnecessary medical services represent the largest source of estimated excess cost in health care at almost $210 billion per year (American College of Physicians, 2018). Providers and nurses are being challenged to become stewards of limited healthcare resources and provide highvalue care to address growing costs and associated waste.
In the inpatient setting, highvalue care has applied to continuous telemetry monitoring. As part of the Choosing Wisely® initiative, the Society of Hospital Medicine (2016) issued the following recommendation: continuous telemetry monitoring outside the intensive care unit (ICU) should not be ordered without a protocol that governs continuation. Outside its primary purpose, continuous telemetry monitoring rarely positively impacts clinical decision making or patient outcomes. Overuse of continuous telemetry monitoring can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion due to delays in inpatient transfer, and increase institutional financial burden (Yeow et al., 2018). Implementation of a nurse-driven evidence-based protocol for discon tinuing continuous telemetry moni toring may reduce inappropriate telemetry use among adult patients hospitalized outside the ICU.
Project Site and Reason for Change
Before initial project planning and design, baseline data were collected for 4 months of continuous telemetry monitoring outside the ICU. The facility has three adult general medical-surgical inpatient units with remote telemetry capabilities, each monitored by a centralized monitoring station. The centralized monitoring station is staffed around the clock by two unlicensed personnel trained as monitor technicians. During the data collection period, monitor technicians tracked the daily patient census on the three inpatient units and the daily total number of patients monitored on telemetry. In addition, the monitor technicians tracked individual data for each continuous telemetry monitoring by recording the date and time each monitor was initiated and then discontinued. This information was provided monthly to the...