Winning Abstracts from the 2006 National Medical Student Abstract Competition: Adherence to the American Heart Association Guidelines for Telemetry Monitoring on a General Medicine Telemetry Unit.
Author: Christopher J. Varughese, Howard University College of Medicine, 2007
The advent of telemetry allowed health care professionals to monitor inpatients that were considered high risk for developing serious cardiac complications. However, studies have shown that not all patients admitted to telemetry units benefit from monitoring and that telemetry monitoring significantly increases the cost of caring for patients (Estrada et. al., 2000).The American Heart Association (AHA) has instituted guidelines for the use of telemetry with patients admitted to non-intensive care units. Cardiac monitoring is indicated for patients with Class I diagnoses. Patients with Class II diagnoses may benefit from cardiac monitoring, though it is not essential. Those patients with Class III diagnoses have low risk for cardiac events and it has been shown that monitoring has no benefit. This study reviews patients admitted to a general medicine telemetry unit and classified their illnesses based on the AHA guidelines.
We reviewed reasoning for admission of 127 patients placed on a non-intensive care unit monitored telemetry ward. A record was kept of the admissions for 30 days. The patients' diagnoses were classified as either Class I, II or III based on the admission information. We then determined the most common diagnosis found in each class.
49 out of 127 patients (38%) were classified as Class I with the most common reason being decompensated congestive heart failure. 43 of the 127 patients (34%) were admitted to the telemetry ward with the most common reason being chest pain and they were identified as Class II. Finally, 35 out of the 127 patients (28%) admitted to the telemetry unit were most consistent with Class III recommendations. Many of the non-cardiac reasons for admission, which include hemodynamically stable lower GI bleeding, and hemodynamically stable anemia were classified into Class III.
In this study, we found that patients in a monitored general medicine ward were not admitted based on AHA recommendations. These results support previous studies that suggest that low risk patients are inappropriately assessed for telemetry monitoring (Estrada et. al., 2000) and may be admitted more as a reassurance tool for both the physicians and health care team (Estrada et al., 2005). In addition, a recent study by Hollander and colleagues has suggested that the routine use of telemetry monitoring for low risk patients with chest pain is of limited utility (Hollander et. al., 2004). This suggests that many of the patients who were categorized into Class II and III should be re-evaluated before they are admitted to monitored beds. The data also suggests and that the role of telemetry in guiding patient management may be overestimated by physicians (Estrada et. al., 1995). Implementation of a checklist for admission to a telemetry unit for the emergency department physicians and staff may be helpful in reducing unnecessary admissions to monitored beds.
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