Patient load effects on response time to critical arrhythmias in cardiac telemetry: a randomized trial.
OBJECTIVE
Remotely monitored patients may be at risk for a delayed response to critical arrhythmias if the telemetry watchers who monitor them are subject to an excessive patient load. There are no guidelines or studies regarding the appropriate number of patients that a single watcher may safely and effectively monitor. Our objective was to determine the impact of increasing the number of patients monitored on response time to simulated cardiac arrest.


METHODS
Randomized trial.


METHODS
Laboratory-based experiment.


METHODS
Forty-two remote telemetry technicians and nurses from cardiac units.


METHODS
Number of patients monitored in a simulation of cardiac telemetry monitoring work.


RESULTS
We carried out a study to compare response times to ventricular fibrillation across five patient loads: 16, 24, 32, 40, and 48 patients. The simulation replicated the work of telemetry watchers using a combination of real recorded patient electrocardiogram signals and a simulated patient experiencing ventricular fibrillation. Study participants were assigned to one of the five patient loads and completed a 4-hour monitoring session, during which they performed tasks-including event documentation and phone calls to report events-similar to real monitoring work. When the simulated patient sustained ventricular fibrillation, the time required to report this arrhythmia was recorded. As patient loads increased, there was a statistically significant increase in response times to the ventricular fibrillation. In addition, frequency of failure to meet a response time goal of less than 20 seconds was significantly higher in the 48-patient condition than in all other conditions. Task performance decreased as patient load increased.


CONCLUSIONS
As participants monitored more patients in a laboratory setting, their performance with respect to recognizing critical and noncritical events declined. This study has implications for the design of remote telemetry work and other patient monitoring tasks in critical and intermediate care units.
1Department of Anesthesiology, Duke University Medical Center, Durham, NC. 2Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 3Procurement Services, Duke University, Durham, NC. 4Trauma Program, University of North Carolina Health System, Chapel Hill, NC. 5Patient Safety Research, CHE Trinity Health and Saint Alphonsus Health System, Boise, ID.
Noa
N
Segall
Gene
G
Hobbs
Christopher B
CB
Granger
Amanda E
AE
Anderson
Alberto S
AS
Bonifacio
Jeffrey M
JM
Taekman
Melanie C
MC
Wright
D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D004562:Electrocardiography; D006801:Humans; D013647:Task Performance and Analysis; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*; D013686:Telemetry / Q000379:methods / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*