title: Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods retrospective data analysis and direct observation study.
abstract: Hospitals have been slow to adopt guidelines from the American Heart Association (AHA) limiting the use of continuous cardiac monitoring for fear of missing important patient cardiac events. A new continuous cardiac monitoring policy was implemented at a tertiary-care hospital seeking to monitor only those patients who were clinically indicated and decrease the number of false alarms in order to improve overall alarm response.
  
  
  
  Leadership support was secured, a cross-functional alarm management task force was created, and a system-wide policy was developed based on current AHA guidelines. Process measures, including cardiac monitoring rate, monitored transport rate, emergency department (ED) boarding rate and the percentage of false, unnecessary and true alarms, were measured to determine the policy's impact on patient care. Outcome measures, including length of stay and mortality rate, were measured to determine the impact on patient outcomes.
  
  
  
  Cardiac monitoring rate decreased 53.2% (0.535 to 0.251 per patient day, p<0.001), monitored transport rate decreased 15.5% (0.216 to 0.182 per patient day, p<0.001), ED patient boarding rate decreased 36.6% (5.5% to 3.5% of ED patients, p<0.001) and the percentage of false alarms decreased (18.8% to 9.6%, p<0.001). Neither the length of stay nor mortality changed significantly after the policy was implemented.
  
  
  
  The observed improvements in process measures coupled with no adverse effects to patient outcomes suggest that the overall system became more resilient to current and emerging demands. This study indicates that when collaboration across a diverse team is coupled with strong leadership support, policies and procedures such as this one can improve clinical practice and patient care.
authors.affiliation: Department of Quality and Safety, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Michael F
authors.identifier: 0000-0003-0180-058X
authors.initials: MF
authors.lastname: Rayo
authors.affiliation: Department of Nursing, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Mansfield
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eiferman
authors.affiliation: Department of Nursing, The Ohio State University, Columbus, Ohio, USA Department of Surgery, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Traci
authors.initials: T
authors.lastname: Mignery
authors.affiliation: School of Health Sciences and Rehabilitation, College of Medicine, Ohio State University, Columbus, Ohio, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: White
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Moffatt-Bruce
mesh_terms: D003142:Communication; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007857:Leadership; D007902:Length of Stay; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Governance; Healthcare quality improvement; Human factors; Implementation science; Leadership