title: Association Between Off-site Central Monitoring Using Standardized Cardiac Telemetry and Clinical Outcomes Among Non-Critically Ill Patients.
abstract: OBJECTIVE
  Telemetry alarms involving traditional on-site monitoring rarely alter management and often miss serious events, sometimes resulting in death. Poor patient selection contributes to a high alarm volume with low clinical yield.
  
  
  OBJECTIVE
  To evaluate outcomes associated with an off-site central monitoring unit (CMU) applying standardized cardiac telemetry indications using electronic order entry.
  
  
  METHODS
  All non-intensive care unit (ICU) patients at Cleveland Clinic and 3 regional hospitals over 13 months between March 4, 2014, and April 4, 2015.
  
  
  METHODS
  An off-site CMU applied standardized cardiac telemetry when ordered for standard indications, such as for known or suspected tachyarrhythmias or bradyarrhythmias.
  
  
  METHODS
  CMU detection and notification of rhythm/rate alarms occurring 1 hour or less prior to emergency response team (ERT) activation, direct CMU-to-ERT notification outcomes, total telemetry census, and cardiopulmonary arrests in comparison with the previous 13 months.
  
  
  RESULTS
  The CMU received electronic telemetry orders for 99,048 patients (main campus, 72,199 [73%]) and provided 410,534 notifications (48% arrhythmia/hemodynamic) among 61 nursing units. ERT activation occurred among 3243 patients, including 979 patients (30%) with rhythm/rate changes occurring 1 hour or less prior to the ERT activation. The CMU detected and provided accurate notification for 772 (79%) of those events. In addition, the CMU provided discretionary direct ERT notification for 105 patients (ventricular tachycardia, n = 44; pause/asystole, n = 36; polymorphic ventricular tachycardia/ventricular fibrillation, n = 14; other, n = 11), including advance warning of 27 cardiopulmonary arrest events (26%) for which return of circulation was achieved in 25 patients (93%). Telemetry standardization was associated with a mean 15.5% weekly census reduction in the number of non-ICU monitored patients per week when compared with the prior 13-month period (580 vs 670 patients; mean difference, -90 patients [95% CI, -82 to -99]; P < .001). The number of cardiopulmonary arrests was 126 in the 13 months preintervention and 122 postintervention.
  
  
  CONCLUSIONS
  Among non-critically ill patients, use of standardized cardiac telemetry with an off-site central monitoring unit was associated with detection and notification of cardiac rhythm and rate changes within 1 hour prior to the majority of ERT activations, and also with a reduction in the census of monitored patients, without an increase in cardiopulmonary arrest events.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cantillon
authors.affiliation: Nursing Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Molly
authors.initials: M
authors.lastname: Loy
authors.affiliation: Nursing Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alicia
authors.initials: A
authors.lastname: Burkle
authors.affiliation: Nursing Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shannon
authors.initials: S
authors.lastname: Pengel
authors.affiliation: Nursing Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Deborah
authors.initials: D
authors.lastname: Brosovich
authors.affiliation: Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Umesh N
authors.initials: UN
authors.lastname: Khot
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Lindsay
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality; D001919:Bradycardia / Q000175:diagnosis; D016638:Critical Illness; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D013610:Tachycardia / Q000175:diagnosis; D013686:Telemetry / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D014481:United States