• Mona Krouss, Sigal Israilov, Daniel Alaiev, Arta Seferi, Tikal Kansara, Gary Brandeis, Carla Saladini-Aponte, Monica Wat, Joseph Talledo, Surafel Tsega, Komal Chandra, Milana Zaurova, Peter A Manchego, Nader Najafi, and Hyung J Cho.
• Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA.
• J Hosp Med. 2023 Feb 1; 18 (2): 147153147-153.

BackgroundTelemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing.MethodsThis quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA) that would fire after the recommended time period for reassessment had passed.ResultsThe average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-h reorder rate. There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner).ConclusionWe successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.© 2022 Society of Hospital Medicine.

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