title: Guideline-based intervention to reduce telemetry rates in a large tertiary centre.
abstract: BACKGROUND
  Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs.
  
  
  OBJECTIVE
  To evaluate the outcomes of guideline-based application of cardiac telemetry.
  
  
  METHODS
  Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward-based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II - baseline) was completed prior to a 3-month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration.
  
  
  RESULTS
  In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean ± standard deviation (SD) age 73 years ± 14.9, 57% male), whilst 65 patients were included in the intervention (mean ± SD age 71 years ± 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 ± 1.8 vs 2.4 ± 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05).
  
  
  CONCLUSIONS
  Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.
authors.affiliation: Department of General Medicine, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Satish
authors.identifier: http://orcid.org/0000-0003-3941-8693
authors.initials: S
authors.lastname: Ramkumar
authors.affiliation: Department of General Medicine, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Tsoi
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Raghunath
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Floyd F
authors.initials: FF
authors.lastname: Dias
authors.affiliation: Department of General Medicine, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Li Wai Suen
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Tsoi
authors.affiliation: Department of General Medicine, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Mansfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D013686:Telemetry / Q000592:standards* / Q000639:trends*; D062606:Tertiary Care Centers / Q000592:standards* / Q000639:trends*
keywords: arrhythmia; guidelines; inpatient; telemetry