title: Does this patient need telemetry? An analysis of telemetry ordering practices at an academic medical center.
abstract: BACKGROUND
  The American Heart Association and Choosing Wisely campaign recommend guideline-based usage of telemetry. Inappropriate use leads to increased costs, alarm fatigue, and inefficient nursing care. This study assesses provider ordering practices for telemetry at a US-based academic hospital.
  
  
  METHODS
  This retrospective study includes all telemetry orders in the medicine and progressive care units from April 2014 to March 2015. Indications were grouped into categories per American Heart Association guidelines.
  
  
  RESULTS
  The top 3 cardiac indications included angina/acute coronary syndrome (35.3%), arrhythmias (19.7%), and heart failure (10.2%). However, noncardiac indications accounted for 20.2% of orders, including respiratory conditions (17.4%), infection (17.4%), substance abuse (14.0%), bleeding (12.4%), vital sign monitoring (10.4%), altered mental status (7.0%), and pulmonary embolus/deep vein thrombosis (7.0%).
  
  
  CONCLUSIONS
  One-fifth of patients were monitored on telemetry for noncardiac indications. We recommend further study on the benefits and risks of telemetry in these patients and systems-based changes for appropriate usage.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Providers for Responsible Ordering, Baltimore, MD, USA.
authors.forename: Stephanie
authors.identifier: http://orcid.org/0000-0002-4608-425X
authors.initials: S
authors.lastname: Chen
authors.affiliation: National Director of Providers for Responsible Ordering, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|National Director of Providers for Responsible Ordering, Providers for Responsible Ordering, Baltimore, MD, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Palchaudhuri
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Providers for Responsible Ordering, Baltimore, MD, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Trost
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ileana
authors.initials: I
authors.lastname: Ponor
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Zakaria
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013686:Telemetry / Q000706:statistics & numerical data*; D014481:United States
keywords: cardiac monitoring; guideline adherence; quality improvement; telemetry