Following AHA guidelines cuts telemetry costs by $13K a day

Integrating American Heart Association (AHA) telemetry guidelines into its electronic ordering system saved a healthcare system $4.8 million annually without compromising patient care, according to a study published online Sept. 22 in JAMA Internal Medicine.

A decade ago, the AHA published recommendations for clinicians on the use of cardiac telemetry in non-intensive care units to help identify cases where telemetry was indicated, might provide benefit or offered no benefit. Robert Dressler, MD, MBA, of the Christiana Care Health System in Newark, Delaware, and colleagues proposed integrating those guidelines into their electronic ordering system to facilitate appropriate use of the technology in their hospitals.

They designed a before-and-after study from Dec. 31, 2012 to Aug. 12, 2013 to assess the effectiveness of the intervention. On March 18, they introduced redesigned and standardized cardiac telemetry orders that deleted sets not supported by the AHA’s guidelines and instituted AHA recommended durations of telemetry.

The algorithm also allowed for protocols if discontinuation of telemetry was thought to be unsafe. They tracked the number of code blues and other measures to assess safety.

Their study showed that the mean weekly number of orders decreased from 1032.3 to 593.2 and the mean duration dropped from 57.8 hours to 30.9 hours. The mean daily number of patients monitored fell from 357.5 to 109.1 while code blue mortality, hospital census and rapid response activations remained similar before and after the intervention.  

The mean daily cost for telemetry in the non-intensive care units decreased from $18,971 to $5,772, for an estimated yearly savings of $4.8 million.

“Our project led to a 70% reduction in telemetry use without adversely affecting patient safety,” Dressler and colleagues wrote. “In fact, patient safety may be enhanced by reducing the potential for alarm fatigue and provider workflow interruptions.”

Nader Najafi, MD, of the University of California, San Francisco, added in an accompanying editorial that the cost savings didn’t include downstream benefits from avoiding unnecessary workups and patient backlogs. He argued that the results show that telemetry is overused and that a randomized clinical trial was in order to evaluate the benefit of telemetry.

“[T]echnology often overtakes scientific evidence in the race to the bedside,” Najafi wrote. “We must remain vigilant against this outcome in the name of patient safety and cost.”