Utilization management in the hospital is everyone’s job. It takes a large number of skilled professionals to care for any hospitalized patient and each of them represents a portion of the cost of care as well. Cardiac telemetry techs are no exception.
Continuous telemetry monitoring is a very commonly used tool for hospitalized patients. The indications for telemetry are numerous. They include chest pain, active arrhythmia, history of arrhythmia, chronic arrhythmia (i.e. atrial fibrillation) and high risk for developing an arrhythmia. While some indications require that the monitoring be continuous, others do not.
All too often, telemetry monitoring is ordered when a patient is admitted to the hospital with very good reason, but is subsequently forgotten. The initial reason for concern is either effectively ruled out or has been adequately resolved, yet no one thinks to stop the telemetry monitoring. Days may pass with the monitor in place with continued indication.
Consider a patient who is admitted with cellulitis of the lower leg, Stage III chronic kidney disease and significant electrolyte abnormalities. Low potassium or magnesium levels warrant telemetry monitoring. However, these issues are resolved within one day. The patient stays four more days for antibiotics to treat the cellulitis. The emergency department physician wrote the initial bridge orders for admission that included the telemetry. Unfortunately, the attending physician performs a general exam every day, but is so focused on the lower leg that the telemetry unit goes unappreciated. Ultimately, the patient has telemetry monitoring for five days rather than one.
So what’s the harm? Well, telemetry requires the utilization of expensive equipment that suffers the wear and tear of normal use. It also requires continuous attention by a trained professional. Every wiggle or trip to the bathroom the patient makes may cause distortion of the signal and cause an inadvertent alarm that requires attention from the person monitoring the telemetry. Furthermore, the monitor system can create a web of wires that is at best an inconvenience to patients and at worst a fall risk. Removing unnecessary telemetry monitors can improve the patient’s safety and satisfaction. This also frees the telemetry tech from additional distraction and allows for focus on monitoring the patients who are still at risk. This may also cut down on alarms and “alarm fatigue” that many telemetry techs face.
In some smaller facilities, the number of units may be limited. Once they are all in service, patients who need monitoring can no longer be admitted or transferred out of higher level of care. Making units available can improve patient throughput.
On most days, an experienced telemetry tech could likely give some insight on patients that are no longer in need of the telemetry monitoring. Of course this insight improves dramatically if the tech is familiar with the patient’s diagnoses, indications for telemetry monitoring and perhaps most importantly, the endpoints for monitoring.
Good utilization management means communicating the right information to the people at every intersection of the patient’s care and empowering those individual’s to use their skill set to help manage the case. Creating systems in which the telemetry monitor tech has access to the necessary information through the electronic record system or requiring that this information be part of a telemetry order are good ways to accomplish the communication flow in one direction. Empowering the telemetry tech to challenge the need for continued monitoring via the utilization management team accomplishes the flow in the other direction.