title: Lack of utility of telemetry monitoring during transport to inpatient beds for identification of dysrhythmias for emergency department patients with potential and known acute coronary syndromes.
abstract: Patients admitted with acute and potential acute coronary syndromes (ACS) frequently required accompaniment by a registered nurse from the emergency department (ED) to inpatient telemetry beds. We tested the hypothesis that telemetry transport monitoring for patients with acute and potential ACS is of limited utility. We conducted a prospective cohort study of patients who were admitted from the ED with acute and potential ACS. Endpoints were life threatening ventricular dysrhythmias requiring intervention and duration of transport time. The setting was an urban tertiary-care emergency department with 55,000 annual visits, and the subjects were adult patients admitted from the ED to inpatient beds (intensive care unit or floor telemetry) with ACS and potential ("rule-out") ACS. Main outcome measures were the development of a life threatening ventricular dysrhythmias during transport, any intervention by the transporting nurse, and the total transport time. Of 315 total admissions involving 310 patients, there were no life threatening ventricular dysrhythmias and interventions during transport [0%; 95% confidence interval 0-0.95%]. The total nurse time out of the ED spent transporting was 13.6 minutes (SD 5.2, range 4-40). The routine use of nurses accompanying patients admitted with acute and potential acute coronary syndromes is of limited utility. Patient transportation without nurses may help alleviate ED overcrowding by saving almost 15 minutes of nursing time currently being used for transport without measurable benefit.
authors.affiliation: University of Pennsylvania School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania 19104, USA. pinesjes@uphs.upenn.edu
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Rich
authors.forename: Anna R
authors.initials: AR
authors.lastname: Schwartz
authors.forename: Rex
authors.initials: R
authors.lastname: Mathew
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Kurz
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Datner
authors.forename: Frank D
authors.initials: FD
authors.lastname: Sites
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander