Evaluation of telemetry utilization, policy, and outcomes in an inner-city academic medical center.
OBJECTIVE
To evaluate the appropriateness and intermediate outcomes of telemetry admissions.


METHODS
We abstracted demographic and clinical data from records of all new telemetry admissions during a 2-month period. To determine appropriateness, 2 authors classified patients using the American College of Cardiology (ACC) guidelines and our telemetry policy. Other utilization and outcome measures were assessed. Agreement between both guidelines was computed (kappa coefficient). Categorical group covariates were compared using chi2 test. Variations in telemetry length of stay (LOS) were compared using Mann-Whitney and Kruskal-Wallis tests. LOS predictors were ascertained by multiple regression analysis.


RESULTS
Of the 120 patients, appropriate admission was 81.6% (ACC criteria) and 83% by our criteria. Guidelines interrater reliability was .89 (kappa). Telemetry events incidence was 33.3%, with 5.8% major and 27.5% minor. LOS was longer among major than minor events group(7.8 vs. 3.4 days, p = .01). Type of telemetry event was a predictor of LOS (p = .0001). The occurrence of a major telemetry event was associated with cardiology consultation (p = .03).


CONCLUSIONS
Appropriate telemetry admission was observed in more than 80% of cases. Our telemetry policy had very good agreement with standard guideline. However, the low rate of major telemetry events in all patient groups suggests current guidelines might have considerable limitations.
Ivonye
Chinedu
C
Department of Medicine, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, USA. civonye@msm.edu
Ohuabunwo
Chima
C
Henriques-Forsythe
Marshaleen
M
Uma
Jamched
J
Kamuguisha
Lois Kemilembe
LK
Olejeme
Kelechi
K
Onwuanyi
Anekwe
A
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005845:Georgia; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D010343:Patient Admission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013686:Telemetry; D014505:Urban Population