Appropriate Use of Telemetry Monitoring in Hospitalized Patients

Abstract

Non-intensive telemetry units are overused in hospitalized patients, either inappropriately initiated in low arrhythmia risk patients or continued beyond the recom- mended duration of monitoring. By far, the largest group of monitored patients is those with chest pain syndromes. The practice guidelines for telemetry monitoring are limited in scope, and chart audits show only moderate adherence by providers; up to 43 % of monitored patients have no indication for monitoring. Review of the available evi- dence supports the selection of a subset of chest pain patients that have a very low risk of arrhythmias. These low-risk patients have a normal or nonspecific ECG, neg- ative cardiac markers, and, depending on the study, either atypical chest pain characteristics, no recurrent chest pain, or a low Goldman risk score. They are unlikely to benefit from telemetry monitoring in the emergency department or observation unit, during transport between hospital units, and in the inpatient setting.