Optimizing telemetry utilization to reduce LOS and increase capacity

Performance improvement in the area of telemetry utilization is challenging and many institutions discover it requires a change in culture and practice. However, the effort has substantial benefit.

Optimizing telemetry utilization and workflow can provide increased capacity, improved efficiency, decreased length of stay, reduced workforce costs, and reduced device and supply use. The bottom line can include a solid return on investment.

Ideal patient capacity in an organization is characterized by a complex yet steady rhythmic flow through the institution. It begins at the access points including the emergency department, transfer center, direct admissions, and surgery and continues to discharge. In order to accommodate incoming patients, those already in-house need to flow efficiently through the system.

Recent studies indicate telemetry monitoring is often used to monitor patients who do not have a clinical need for it and disruption in patient flow can be linked to a number of telemetry issues:^1,2,3,4

• Overuse/overordering of telemetry monitoring 
• Lack of education regarding the evidence based guidelines for telemetry 
• Inadequate system design to control telemetry initiation (order entry/engineering controls) 
• Lack of or inadequate system design to discontinue telemetry 

There are many strategies that can be applied to improving telemetry utilization including: 

• Development of standardized protocols
• Electronic health records (EHRs) to create a standardized order-set for initiation of telemetry
• Additional education on appropriate telemetry use, benefits, and evidence-based practices 
• A “gate-keeper” model where all telemetry has to meet given criteria or be reviewed prior to initiation
• A timed reminder to reassess telemetry need 
• Use of alterative monitoring strategies (i.e. early warning systems)

When successfully implemented, performance improvement in the area of telemetry utilization can help improve patient flow and release needed capacity. It can also can produce significant ROI based on cost savings and cost avoidance through decreased LOS, elimination of unnecessary staff hours, decreased unneeded testing, and supply savings. An additional area of savings which is not always considered is the costs associated with the battery disposal process - which also has an impact on the environment.