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Clin Cardiol. 2019 Aug 12. doi: 10.1002/clc.23244. [Epub ahead of print]

Indication-specific event rates among hospitalized patients undergoing continuous cardiac monitoring.

Author information

1
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
2
Nursing Institute, Cleveland Clinic, Cleveland, Ohio.
3
Internal Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio.
4
Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
5
Community Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio.
6
Clinical Engineering, Cleveland Clinic, Cleveland, Ohio.

Abstract

BACKGROUND:

Cardiac telemetry monitoring is widely utilized for a variety of clinical indications, yet indication-specific event rates for monitored patients are seldomly reported.

HYPOTHESIS:

High-risk hospitalized patients for clinical deterioration can be identified using standardized telemetry monitoring indications.

METHODS:

Adjudicated data from events triggering emergency response team (ERT) activation were systematically characterized at the Cleveland Clinic from among standardized telemetry indications ordered over a 13-month period.

RESULTS:

Among 72 199 orders created for telemetry monitored patients, ERT activation occurred in 2677 patients (3.7%), of which 1326 (49.5%) were cardiac-related. Patients with deep venous thrombosis or pulmonary embolism (DVT/PE) demonstrated the highest overall event rate (ERT: n = 41 of 593 pts [6.9%]; 25/41 cardiac related [61%]). Cardiac-related events were proportionally highest among patients with coronary disease awaiting revascularization (ERT: n = 19 of 847 patients [2.2%]; 13/19 cardiac-related [68.4%]). Arrhythmia-specific events were highest among patients who underwent cardiac surgery (n = 78 of 193 cardiac-related ERT [40.4%]), and patients with known or suspected tachyarrhythmias (n = 318 of 788 cardiac-related ERT [40.4%]). Bubble plot analysis identified patients hospitalized with DVT/PE, drug or alcohol exposures, and acute coronary syndrome as among the highest overall and cardiac-related events while identifying patients with respiratory disorder monitoring indications as carrying the highest noncardiac event rate.

CONCLUSION:

High-risk hospitalized patients can be identified by telemetry indication and prioritized according to concerns for cardiac, arrhythmia-specific and noncardiac clinical deterioration. This is particularly useful when monitored bed resources are constrained.

KEYWORDS:

alarm fatigue; arrhythmias; cardiac telemetry; monitoring

PMID:
31407351
DOI:
10.1002/clc.23244
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