Are Monitored Telemetry Beds Necessary for Patients With Nontraumatic Chest Pain and Normal or Nonspecific Electrocardiograms?

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Acknowledgements

We thank the emergency department nurses, physicians, and academic associates for their assistance with patient enrollment, and Jason Cullin and Sultan Khan for their assistance with data management.

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    2020, American Journal of Emergency Medicine
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    Until a combination of hardware and software technologies emerge to produce a highly sensitive and highly specific monitoring system, more selective monitoring may be key to reducing alarm frequency and the resulting alarm fatigue. For example, many patients monitored in the ED or admitted to telemetry beds are low-risk patients with chest pain, and multiple studies have shown little to no benefit of monitoring in this group [19-23]. EDs could implement protocols to restrict continuous monitoring only to patients with significant potential for clinical decline based on the treating clinician's judgement.

  • 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

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    Monitoring low-risk patients who are unlikely to experience cardiac arrhythmias may yield a disproportionate ratio of false alarms including noise artifact and ECG lead failures. For example, arrhythmia yield was only 1.5% in one study of “low-risk” hospitalized patients admitted with chest pain and normal or nonspecific ECG findings (Hollander et al., 1997). The AHA practice guidelines in 2004 (Drew et al., 2004) omitted many commonly applied telemetry indications including stroke evaluation, hypoxemic respiratory disorders, proarrhythmic acid/base disorders, and exposures to pro-arrhythmic drugs (dofetilide, sotalol) or illicit substances (cocaine, amphetamines, alcohol intoxication) (Henriques-Forsythe et al., 2009).

  • Over-monitoring and alarm fatigue: For whom do the bells toll?

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