Customer story

Optimizing telemetry utilization to reduce LOS and increase capacity

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Performance improvement of telemetry utilization can help improve patient flow and 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.

Decreased LOS
Staff Hours
Unneeded Testing
Supply Savings

Telemetry utilization and capacity

 

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 

Strategies to improve telemetry utilization

 

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)
telemetry graphic

Conclusions

 

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.

Decreased LOS
Staff Hours
Unneeded Testing
Supply Savings

References

1. Chahine, J., Thapa, B., Gosai, F., Abdelghaffar, B., Al-Ashi, S., Maroo, A., et al. (2019). Interventions to decrease overuse of cardiac monitoring (telemetry) when transitioning from the intensive care unit to the regular nursing floor. Cureus. 11(3). https://doi.org/10.7759/cureus.4311 

2. Dressler, R., Dryer, M.M., & Coletti, C. (2014). Altering overuse of cardiac telemetry in non-intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA Internal Med. 174(11): 1852-1854. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1906998 

3. Maduke, T., Qureshi, B., Goite, Y., Gandhi, K., Bofarrag, F. Liu, L., et al. (2019) Monitoring the use of a telemonitor: A resident run quality improvement initiative decreases inappropriate use of telemonitor in a community hospital. Cureus. 11(11). https://doi.org/10.7759/cureus.6263 

4. Henriques-Forsythe, M.N., Ivonye, C.C., Jamched, U., Kamuguisha, L.K.K., Olejeme, K.A., and Onwuanyi, A.E., (2009). Is telemetry overused? Is it as helpful as thought?. Cleveland Clinic Journal of Medicine. 76(6): 368-372. https://doi.org/10.3949/ccjm.76a.07260

Meet our team

Beth Fuller

John Davanzo

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. 
Lisa Pahl

Lisa Pahl, RN, BSN, MSN

Principal and Practice Operations Lead

Lisa is a recognized expert in alarm fatigue and alarm management. She is a member of the AAMI Healthcare Technology Safety Institute’s national Clinical Alarms Steering Committee and often presents on alarm management.

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