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Evaluating telemetry utilization and alarm management practices

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Optimizing processes for greater efficiency

With the expectation of a hospital-wide installation of new telemetry equipment, Huntsville Hospital wanted to conduct a current-state assessment of their telemetry monitoring program so processes could be optimized and in place when the new equipment arrived.

Huntsville Hospital and Philips set out together to evaluate the central monitoring unit (CMU) and telemetry monitoring and alarm management practices to identify improvement opportunities in current processes so the hospital could act on improvement recommendations prior to installation.

As a result of the assessment, Philips consultants identified 23 opportunities and recommendations for performance improvement, which were detailed and presented to hospital leadership.

With a centralized monitoring room, the noise level alone is often overwhelming to technicians. The recommended changes made an immediate difference in the noise level that was noticed and felt by all, making for a much healthier and safer work environment. We feel patients are also much safer because the technicians can focus on true and valid alarms and limit the number of notifications to RNs thereby reducing their workload.”

Wendy Cantrell, MSHR Manager, Telemetry Monitoring

Huntsville Hospital

Our approach

Elements of the effort included:

Data Analytics – Prior to the onsite visit, a month of telemetry data was analyzed to understand the monitoring alarm history, identify potential configuration issues, and review default settings challenges
Stakeholder Interviews – Onsite interviews with executive leadership, physicians, quality manager, nurse director, nurse manager, charge nurses and monitoring techs (MTs) helped to identify the issues and fully understand the culture
Site Assessment – Current processes were analyzed for the telemetry units and alarm management protocols to determine what was working well and where there was room for improvement
Review of Policies & Procedures – A thorough review of policies and procedures was completed to discover if practices adhered to policy and if actions aligned with the Joint Commission recommendations
Observations – Nurses and MTs were shadowed to better understand daily routines and actual practices and to observe real-time challenges

Recommendations

Numerous challenges such as lack of telemetry order guidance, poor alarm customization, and alarm fatigue were identified and considered during the course of the engagement. Based on these findings, Philips consultants identified 23 specific opportunities for improvement. The top 10 being:

Modify medium priority arrhythmia alarm settings
Improve telemetry utilization criteria
Establish telemetry continuation/discontinuation criteria
Define instructions to reduce leads off alarms
Clarify electrode changes and skin prep procedures
Clarify customization (people & practice) roles and responsibilities
Establish an alarm committee
Modify MT alarm load and number of sectors
Create alarm settings & review: CMU consistency
Establish visual control: cardiac step-down satellite CMU station

Next steps

Upon completion of the engagement, Huntsville Hospital decided to move forward with the recommendations. When the equipment upgrade is ready for implementation, Huntsville Hospital’s telemetry monitoring program will be positioned to optimize the new technology.

The assessment report allowed us to make changes based on true data and not merely what we “thought” were our problems and concerns.”

Wendy Cantrell, MSHR Manager, Telemetry Monitoring

Huntsville Hospital

* Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.

Huntsville Hospital serves as the regional referral center for North Alabama and Southern Tennessee and is a teaching facility for the University of Alabama’s Family Practice and Internal Medicine residency programs. It is also home to one of only three statewide Level I Trauma Centers.

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Meet our team

John Davanzo, MBA, BSN, RN, CEN, EMT-P, NEA-BC, FACHE

Consulting Manager

John brings expertise in hospital operations, workflow, and process redesign. He is a regular regional and national presenter on healthcare topics including process and resource efficiency as well as use of simulation in healthcare. He is a Fellow in the American College of Healthcare Executives. His clinical expertise includes emergency care, pre-hospital care, and pediatric and adult ICU.

Dale Roberts RN, NP