Standardized cardiac telemetry with off-site central monitoring helps outcomes in non-critically ill patients

An analysis of non-intensive care unit patients at the Cleveland Clinic and three regional hospitals found that using standardized cardiac telemetry with an off-site central monitoring unit helped detect rate and rhythm changes in 79 percent of patients within an hour of an emergency response team activation.

Lead researcher Daniel J. Cantillon, MD, of the Cleveland Clinic, and colleagues published their results online in JAMA on Aug. 2.

During the study, which lasted between March 4, 2014, and April 4, 2015, the central monitoring unit received electronic telemetry orders for 99,048 patients and provided 410,534 notifications among 61 nursing units. The Cleveland Clinic applied guideline-based standardized telemetry criteria, which were developed by a physician and nursing task force.

With this model, a monitoring technician provided continuous cardiac monitoring for up to 48 patients, while lead technicians provided on-site oversight and supervision for real-time rhythm interpretation and detection management. The central monitoring unit and nurses shared responsibility for monitoring patients.

Of the electronic telemetry orders, 73 percent were placed at the Cleveland Clinic and 27 percent were placed at three regional hospitals. The most common reason for cardiac telemetry was for known or suspected atrial or ventricular tachyarrhythmias.

The emergency response team responded to 3,243 patients, including 979 patients with rhythm/rate changes within an hour of emergency response team activation. The central monitoring unit provided accurate notification for 79 percent of the events and provided discretionary direct emergency response team notification for 105 patents. Of the 105 patients, 44 had ventricular tachycardia, 36 had pause/asystole, 14 had polymorphic ventricular tachycardia/ventricular fibrillation and 11 had other symptoms.

The researchers said that telemetry standardization was associated with a mean 15.5 percent weekly census reduction in the number of non-intensive care unit monitored patients per week compared with the previous 13 months. They added that the reduction in telemetry census occurred within the first week and was sustained during the 13 months.

The researchers cited a few limitations of the study, including its lack of a randomized or crossover design. They also said the results may not be generalizable to other hospitals or medical centers. Still, they mentioned the findings could help inform future studies.

“Normal hospital activities occurring at the nursing station might potentially distract on-site personnel from continuous vigilant patient monitoring, in addition to the possibility of vigilance being divided by other on-site duties,” they wrote. “Off-site monitoring allows dedicated personnel to provide patient moni- toring removed from the hospital wards with centralized staffing and standardized practices. A [central monitoring unit] also allows oversight and supervision by lead technicians (in other words, somebody to watch those who are watching) to try to ensure continuous monitoring and mitigate lapses.”