A nurse practitioner intervention model to maximize efficient use of telemetry resources.
BACKGROUND
Telemetry monitoring is widely used in hospitals; the importance of being able to monitor and examine dysrhythmias has been universally accepted. Yet it is often used for patients who do not actually require this technology. A model to improve the efficiency of telemetry use entailed the use of an advanced practice nurse (APN; identical to a nurse practitioner) to provide concurrent review and intervention of floating telemetry, which is available for patients independently of the floor location and who do not need an intensive care unit bed. ADDRESSING OVERUSE: The demand for floating telemetry at Hackensack University Medical Center had equaled or exceeded the telemetry availability virtually 100% of the time, even after local guidelines had been disseminated in 1998. The APN carried out concurrent monitoring and intervened with the attending physician when patients were on telemetry for longer than 48 hours and did not meet the local telemetry guidelines.


RESULTS
The mean number (standard error [SE]) of hours per patient declined from 65.2 +/- 0.7 hours (95% confidence interval, 63.8 to 66.6 hours) for the 11 months before the intervention to a mean of 49.6 +/- 0.4 hours (95% confidence interval, 48.7 to 50.2 hours) for the 29 months after intervention--representing a decrease of 34% (p < 0.0001). This decrease led to an increase in the number of patients per month put on telemetry.


CONCLUSIONS
The APN model, an aggressive approach that induced change almost immediately, was then applied to other quality improvement projects.
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D003211:Concurrent Review; D017598:Efficiency, Organizational; D004562:Electrocardiography / Q000592:standards / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009515:New Jersey; D009722:Nurse Practitioners / Q000193:education; D017410:Practice Guidelines as Topic; D013686:Telemetry / Q000592:standards / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D017749:Total Quality Management / Q000379:methods*