title: Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost.
abstract: BACKGROUND
  Telemetry monitoring is a widely used, labor-intensive, and often-limited resource. Little is known of the effectiveness of methods to guide appropriate use.
  
  
  OBJECTIVE
  Our intervention for appropriate use included: (1) a hospitalist-led, daily review of bed utilization, (2) hospitalist-driven education module for trainees, (3) quarterly feedback of telemetry usage, and (4) financial incentives.
  
  
  METHODS
  Hospitalists were encouraged to discuss daily telemetry utilization on rounds. A module on appropriate telemetry usage was taught by hospitalists during the intervention period (January 2013-August 2013) on medicine wards. Pre- and post-evaluations measured changes regarding telemetry use. We compared hospital bed-use data between the baseline period (January 2012-December 2012), intervention period, and extension period (September 2014-March 2015). During the intervention period, hospital bed-use data were sent to the hospitalist group quarterly. Financial incentives were provided after a decrease in hospitalist telemetry utilization.
  
  
  METHODS
  Stanford Hospital, a 444-bed, academic medical center in Stanford, California.
  
  
  RESULTS
  Hospitalists saw reductions for both length of stay (LOS) (2.75 vs 2.13 days, P = 0.005) and total cost (22.5% reduction) for telemetry bed utilization in the intervention period. Nonhospitalists telemetry bed utilization remained unchanged. We saw significant improvements in trainee knowledge of the most cost-saving action (P = 0.002) and the least cost-saving action (P = 0.003) in the pre- and post-evaluation analyses. Results were sustained in the hospitalist group, with telemetry LOS of 1.93 days in the extension period.
  
  
  CONCLUSIONS
  A multipronged, hospitalist-driven intervention to improve appropriate use of telemetry reduces LOS and cost, and increases knowledge of cost-saving actions among trainees.
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: David
authors.initials: D
authors.lastname: Svec
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Neera
authors.initials: N
authors.lastname: Ahuja
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Kambria H
authors.initials: KH
authors.lastname: Evans
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Hom
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Trit
authors.initials: T
authors.lastname: Garg
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Pooja
authors.initials: P
authors.lastname: Loftus
authors.affiliation: Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shieh
mesh_terms: D000046:Academic Medical Centers; D002140:California; D017721:Hospital Costs; D020445:Hospitalists / Q000193:education*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D009042:Motivation; D017063:Outcome Assessment, Health Care; D013663:Teaching; D013686:Telemetry / Q000191:economics / Q000706:statistics & numerical data*