You're Probably Wasting Money on Cardiac Telemetry Overuse

Inappropriate utilization of cardiac telemetry is wasteful spending with no significant clinical benefit.

Eliminating inappropriate use of cardiac telemetry can generate significant cost savings for health systems and hospitals, recent research shows.

Healthcare spending accounts for about 18% of the country's gross domestic product, with the figure expected to reach nearly 20% by 2025. Wasteful spending is estimated to represent about one-third of healthcare expenditures.

Cardiac telemetry is an observation tool that allows continuous monitoring of electric and other heart signals.

Research published this month in the American Journal of Cardiology found a significant level of wasteful utilization of cardiac telemetry at a 432-bed tertiary hospital. The researchers examined data from 250 consecutive patients admitted to telemetry-capable beds:

• The patients were hospitalized a total of 1,640 days, with 1,399 days on telemetry.
   
• The researchers found that only 334 telemetry days were appropriate based on established national guidelines.
   
• Compared to a patient's non-telemetry hospital day, the cost of telemetry was about $34 per day.
   
• For the patients in the study, the hospital could have saved $37,000 by eliminating inappropriate telemetry utilization. The estimated annual savings from a similar patient cohort would have been more than $500,000.

The researchers found no significant clinical benefit from overutilization of cardiac telemetry.

For the 250 patients in the study, 16 significant arrhythmias were detected during their hospitalizations. All of the arrhythmias were detected during appropriate telemetry days.

There were similar findings for clinical decisions driven by telemetry days and code calls, the researchers wrote.

"All five code calls were due to respiratory arrest, with four being on appropriate telemetry days and one on an inappropriate telemetry day. There were 18 significant clinical decisions motivated by telemetry findings during appropriate telemetry days, with only one such decision made on an inappropriate telemetry day," they wrote.

Appropriate utilization
 

There are two sets of national standards for the appropriate utilization of cardiac telemetry: the 2004 American Heart Association Practice Standards and 1991 American College of Cardiology guidelines.

Under the 2004 AHA practice standards and 1991 ACC guidelines, there are more than a dozen indications for cardiac telemetry including the following:

• Patients with chest pain syndromes
   
• Patients under evaluation for syncope
   
• New onset atrial fibrillation with or without rapid ventricular response
   
• Patients with severe electrolyte abnormalities
   
• Newly diagnosed stroke
   
• Patients with other acute neurological events
   
• Patients emerging from sedation or anesthesia for procedures

The AHA and ACC directives are likely a key component of eliminating inappropriate utilization of cardiac telemetry, the American Journal of Cardiology researchers wrote.

"Potential reasons for telemetry overuse include lack of awareness of the AHA/ACC guidelines, nonadherence to these guidelines, lack of provider awareness of ongoing telemetry use, and a lack of telemetry auditing. These causes have been described in previous studies and should be a target for future study and intervention."

Addressing inappropriate utilization
 

This week, the lead author of the research told HealthLeaders that some hospitals are trying to address inappropriate utilization of cardiac telemetry.

"Some centers are instituting daily huddles regarding ongoing care in order to improve quality and reduce waste," said Daniel Morin, MD, MPH, medical director of cardiovascular research at John Ochsner Heart and Vascular Institute in New Orleans.

"These meetings may include review of which patients are on telemetry. These patients are then reviewed for whether they should remain on telemetry, and if not, telemetry may be discontinued, at a significant savings as we discussed in our paper. Conversely, when an indication for telemetry is present for a nonmonitored patient, telemetric monitoring can be initiated."