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Continuous Monitoring - Telemetry

The high cost of telemetry overuse — and how continuous vital signs monitoring can help ease the burden and burnout

patient in hospital ward using a walker

Implementing wireless and wearable continuous vital signs monitoring for non-cardiac patients may help health systems and hospitals optimize patient care, reduce clinician burnout, and drive economic advantages.

01. How common is overuse of telemetry monitoring?

  • #9 among the top health technology hazards: Overuse of cardiac telemetry can cause clinician cognitive overload and missed critical events. [1]
  • 75% of physicians are comfortable with the idea of discontinuing telemetry monitoring based on American Heart Association (AHA) guidelines. [2]
81%
81% of physicians somewhat or strongly agree that cardiac telemetry is overused.[3]

Paradoxically, increased use of cardiac telemetry monitoring (for patients who do not require it) can lead to patients overall being less effectively monitored.

ECRI [4]

02. Conditions for which non-cardiac patients might be monitored in telemetry beds

  • COPD exacerbation, pneumonia, pulmonary embolism, sepsis and blood hemorrhaging.[5]
  • Gastrointestinal bleeding, renal failure.[6]
  • End-stage renal disease, low-risk chest pain, syncope from non-cardiac causes.[7]

03. Problems telemetry overuse is creating

  • Higher costs, diminished patient throughput, and increased length of stay.[8]
  • Unnecessary alarms for already-overburdened clinicians [9] who are prone to alarm fatigue,[10] which can lead to medical errors, increase burnout, and interfere with patient recovery.[11]

Persistent and probing questions about telemetry

  • Is telemetry as helpful as previously thought? [12]
  • Is telemetry overuse impeding cost-effective patient care? [13]

04. Benefits of implementing continuous vital signs monitoring

While solutions to telemetry overuse include educating caregivers about AHA guidelines, [14] and building order sets and reminders into EHRs, [15] these have not focused on improving surveillance for non-cardiac patients who would benefit from continuous monitoring of vital signs, including:

  • Respiratory rate
  • Pulse rate
  • SpO2

Improving the patient experience

  • Respiratory rate is a good indicator of impending decompensation but is often neglected as a vital sign. [16]
  • Now, wireless and wearable sensors can accurately track respiratory rate with high sensitivity for early-stage detection of deterioration. [17]
  • Pulse oximetry is also effective because a single sensor can provide timely indication of changes in patient state and is well-tolerated by patients. [18]

05. Reducing clinician burden and burnout

A Cleveland Clinic study funded by GE HealthCare measured the respiratory rate, oxygen saturation, and pulse rate of 100 post-surgical patients with continuous monitoring. Through the use of an alarm burden analytic to optimize actionable alarms and minimize non-actionable alerts, Cleveland Clinic was able to achieve averages of less than one alarm per day for all Portrait™ Mobile patients and an average of 2.3 for patients with alarms. [19]

Reducing false alarms can help alleviate burnout [20] and free up nurses who spend an average 20 minutes per day on every telemetry patient. [21]

less than 1 alarm per day for all Portrait™ Mobile patients and an average of 2.3 for patients with alarms. [18]

06. Driving economic advantages

In addition to improving the patient experience and reducing clinician burden, minimizing unnecessary use of telemetry has been shown to drive cost-savings:

  • $37,995.84 Per Month
    the amount telemetry monitoring for non-AHA guideline patients cost an urban, tertiary care teaching hospital. [22]
  • $4.8 million Annually
    the savings a health system achieved by reducing the mean daily number of patients monitored with telemetry by 70%. [23]