Tell-a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system.

Autor: Krouss M; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA.; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Israilov S; Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Alaiev D; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA., Seferi A; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA., Kansara T; Department of Medicine, Cleveland Clinic, Dover, Ohio, USA., Brandeis G; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Saladini-Aponte C; Department of Medicine, NYC Health + Hospitals/Jacobi, The Bronx, New York, USA., Wat M; Department of Medicine, NYC Health + Hospitals/Kings County, Brooklyn, New York, USA., Talledo J; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA., Tsega S; Department of Medicine, NYC Health + Hospitals/Kings County, Brooklyn, New York, USA., Chandra K; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA., Zaurova M; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA.; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Manchego PA; Department of Quality and Safety, NYC Health + Hospitals, New York, New York, USA.; Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York, USA., Najafi N; Department of Medicine, University of California San Francisco, San Francisco, California, USA., Cho HJ; Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of hospital medicine [J Hosp Med] 2023 Feb; Vol. 18 (2), pp. 147-153. Date of Electronic Publication: 2022 Dec 25.
DOI: 10.1002/jhm.13030
Abstrakt: Background: Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing.
Methods: This quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA) that would fire after the recommended time period for reassessment had passed.
Results: The average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-h reorder rate. There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner).
Conclusion: We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.
(© 2022 Society of Hospital Medicine.)
Databáze: MEDLINE
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