麻豆传媒

Reducing use of cardiac telemetry outside the ICU is unlikely to miss treatment-changing or life-threatening arrhythmias, a single-center study affirmed.

Only occurred out of the 7,200 total alarms at the center before or after revisions to the electronic ordering system protocol based on a to cut back on use outside the ICU.

"This patient had a self-terminated ventricular tachycardia that lasted 32 seconds," , Christiana Care Health System in Newark, Del., and colleagues wrote online in JAMA Internal Medicine.

"Thus, there was not a single life-threatening arrhythmia for which telemetry led to an immediate treatment during the study period."

While 37.2% of the 78 emergency alarms were deemed clinically-important, only 14 (48.3%) of those led to a change in clinical management within an hour. "Most of these alarms were for rapid atrial tachyarrhythmia," Doorey's group noted in the research letter.

Duration of telemetry declined (mean 2.58 versus 1.55 days, P<0.001) after the revision of the protocols in March 2013 to hardwire in the criteria, which had already been in use there.

The group had previously reported that the protocols cut without an increase in mortality, cardiac arrest, or activation of the rapid response team.

By using the AHA guidelines as an evidence-basis for the protocols, the system may mitigate medicolegal concerns that contribute to telemetry overuse, the researchers suggested.

"Thus, reducing unnecessary telemetry use is not likely to miss life-threatening alarms because of the very low incidence of true life-threatening alarms in contemporary telemetry monitoring settings," they wrote. "This finding should be reassuring to those considering the recommendation of the Choosing Wisely campaign to limit nonintensive care unit telemetry."

An called the findings a teachable moment.

"Telemetry is designed to aid in the management of active cardiac conditions but instead is frequently used for stable arrhythmias or closer monitoring of noncardiac conditions," , and , both of Johns Hopkins Bayview Medical Center in Baltimore, wrote.

"Routinely assessing if a telemetry box is present on physical examination can prompt us to question whether monitoring is necessary," they suggested. "We need to understand the limitations of telemetry for nonguideline indications and that it does not replace closer clinical monitoring outside of the intensive care unit."

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