Off-Site Cardiac Telemetry Monitoring in Non–Critically Ill Patients
What are the outcomes associated with an off-site central monitoring unit (CMU) applying standardized cardiac telemetry indications using electronic order entry?
All non–intensive care unit (ICU) patients at Cleveland Clinic and three regional hospitals over 13 months between March 4, 2014 and April 4, 2015 were included. An off-site CMU applied standardized cardiac telemetry when ordered for standard indications, such as for known or suspected tachyarrhythmias or bradyarrhythmias. The main outcome measures were CMU detection and notification of rhythm/rate alarms occurring 1 hour or less prior to emergency response team (ERT) activation, direct CMU-to-ERT notification outcomes, total telemetry census, and cardiopulmonary arrests in comparison with the previous 13 months.
The CMU received electronic telemetry orders for 99,048 patients (main campus, 72,199 [73%]) and provided 410,534 notifications (48% arrhythmia/hemodynamic) among 61 nursing units. ERT activation occurred among 3,243 patients, including 979 patients (30%) with rhythm/rate changes occurring 1 hour or less prior to the ERT activation. The CMU detected and provided accurate notification for 772 (79%) of those events. In addition, the CMU provided discretionary direct ERT notification for 105 patients (ventricular tachycardia, n = 44; pause/asystole, n = 36; polymorphic ventricular tachycardia/ventricular fibrillation, n = 14; other, n = 11), including advance warning of 27 cardiopulmonary arrest events (26%), for which return of circulation was achieved in 25 patients (93%). Telemetry standardization was associated with a mean 15.5% weekly census reduction in the number of non-ICU monitored patients per week when compared with the prior 13-month period (580 vs. 670 patients; mean difference, −90 patients [95% CI, −82 to −99]; p < 0.001). The number of cardiopulmonary arrests was 126 in the 13 months preintervention and 122 postintervention.
The authors concluded that among non–critically ill patients, use of standardized cardiac telemetry with an off-site CMU was associated with detection and notification of cardiac rhythm and rate changes within 1 hour prior to the majority of ERT activations.
This study reports that the use of a centralized monitoring unit with standardized order entry accurately detected and reported adjudicated rhythm and rate changes within 1 hour of an ERT activation and without an increase in cardiopulmonary arrest events. Off-site monitoring allows dedicated personnel to provide patient monitoring removed from the hospital wards with centralized staffing and standardized practices. A CMU also allows oversight and supervision by lead technicians to try to ensure continuous monitoring and mitigate lapses. Future work and technological innovation may further improve efficiency and reduce costs of centralized monitoring. Additional prospective studies are indicated to validate these single tertiary system findings.
Keywords: Arrhythmias, Cardiac, Bradycardia, Critical Illness, Heart Arrest, Heart Conduction System, Hemodynamics, Intensive Care Units, Outcome Assessment (Health Care), Tachycardia, Ventricular, Telemetry, Ventricular Fibrillation
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