Moreover, since the publication of these guidelines, there have been several studies published by individual hospitals and health systems that have either instituted their own modified version of the guidelines or questioned the utility of continuous monitoring for specific conditions. This guideline provides some evidence-based recommendations for cardiac diseases, but has limited details on the duration of monitoring and excludes many non-cardiac conditions. In an effort to establish some consistency among providers, the American Heart Association (AHA) and American College of Cardiology (AHA) published their recommendations for appropriate use of telemetry in hospitalized patients, categorizing them as class I (all patients require telemetry), class II (some may benefit from telemetry), and class III (telemetry not indicated). However, because the telemetry data are often transmitted wirelessly to the central station, providers have observed delays as long as 5 s between the real-time status of the patient and the information displayed on the monitor. In one institution, the alarms were so loud and disruptive to the people working in those units that they were often silenced, so the providers had to rely on technicians who were watching the monitors at the central telemetry station to notify them immediately about patient events. The majority (80 %) of the alarms were found to be false triggers that did not result in a clinical intervention, but significantly interrupted the workflow of the healthcare provider, who would have to go to the bedside to assess the patient and turn off the alarm. Artifacts can also trigger the tachycardia or bradycardia alarms on these hospital units, contributing to “alarm fatigue,” and desensitize staff from patients that have real dysrhythmias. Patients have undergone unnecessary diagnostic or therapeutic interventions (e.g., precordial thump, anti-arrhythmic medications, internal cardioverter-defibrillator placement) as a result of electrocardiographic artifacts mimicking ventricular tachycardia. Several unintended clinical consequences of telemetry monitoring have been reported in the literature. However, telemetry monitoring may also be used for patients with non-cardiac conditions associated with a risk for developing arrhythmias (e.g., pneumonia, stroke ) or as an inappropriate substitute for nursing care or close observation. These patients are often admitted to a telemetry unit because of their risk of developing a cardiac dysrhythmia. Acute chest pain remains one of the primary reasons for ED visits, and cardiac-related diagnoses are among the top ten reasons for hospital admissions. More than simply increasing healthcare costs, the overuse of telemetry also contributes to emergency department (ED) boarding and crowding, as the need for telemetry beds overwhelms a hospital’s capacity. Subsequently, the appropriate use of cardiac monitoring has become one of its initiatives of the American Board of Internal Medicine Foundation’s Choosing Wisely ® campaign to decrease wasteful healthcare spending. In 2013, the Society of Hospital Medicine identified continuous cardiac monitoring as one of the top five treatments relevant to their practice that is frequently overused in the hospital setting. Moreover, most in-hospital cardiac arrests in adults are not preceded by sudden shockable arrhythmias, but rather with respiratory failure, circulatory shock, or both. Its benefit in less acutely ill patients is not as clear. In patients admitted to cardiac intensive care units, continuous cardiac monitoring has been shown to reduce mortality rates following in-hospital cardiac arrest because early detection led to early defibrillation. If healthcare personnel can immediately recognize a life-threatening arrhythmia in an unwitnessed cardiac arrest, they may be able to intervene and improve survival. Non-intensive cardiac telemetry units were originally designed to monitor hospitalized patients at risk for life-threatening dysrhythmias, but did not require the level of care provided by intensive care units.
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