Abstract

Inappropriate use of telemetry frequently occurs in the inpatient, non-intensive care unit setting. Recent telemetry practice standards have attempted to guide appropriate use and limit the overuse of this important resource, with limited success. Clinical-effectiveness studies of these practice standards have thus far not included care settings in which resident-physicians are the primary caregivers. Furthermore, studies of the role of nurses in appropriate telemetry use are lacking. In this report, we describe two interventions implemented on general internal medicine units of a large academic hospital over three years. The first intervention, or nurse-discontinuation protocol, allowed nurses to trigger the discontinuation of telemetry once the appropriate duration had passed according to practice standards. The second intervention, or physician-discontinuation protocol, instituted a Best Practice Advisory that notified the resident-physician via the electronic medical record when the appropriate telemetry duration for each patient had elapsed and suggested termination of telemetry. Results showed that the nurse-discontinuation protocol reduced mean patient time on telemetry and the physician-discontinuation protocol reduced mean telemetry orders per patient. These findings validate a prior study and expand on our understanding of telemetry use in the academic care setting in which trainees serve as the primary caregivers.