Role of telemetry monitoring in the non-intensive care unit

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Abstract

To determine the outcomes of patients admitted to a non-intensive care telemetry unit and to assess the role of telemetry for guiding patient management decisions, data from 2,240 patients admitted to a telemetry unit were collected prospectively during 7 months. Physicians recorded the outcomes (intensive care unit transfer and mortality) and assessed whether telemetry assisted in guiding patient management. Indications for admission to the telemetry unit included chest pain syndromes (55%), arrhythmias (14%), heart failure (12%), and syncope (10%). Telemetry led to direct modifications in management in 156 patients (7%; 95% confidence interval [CI] 5.9% to 8%). Telemetry was perceived as useful but did not alter management for 127 patients (5.7%; 95% CI 4.7% to 6.6%). Two hundred forty-one patients were transferred to an intensive care unit from the telemetry unit (10.8%; 95% CI 9.5% to 12%). Nineteen patients (0.8% of all admissions; 95% CI 0.5% to 1.2%) were transferred because of an arrhythmia identified by telemetry. Routine transfer after cardiac revascularization or surgery accounted for 134 transfers; clinical deterioration accounted for 88 transfers. There were 20 deaths in the unit (0.9%; 95% CI 0.5% to 1.3%): 4 of the 20 deaths occurred while patients were being monitored. The role of telemetry in guiding patient management may be overestimated by physicians, since it detected significant arrhythmias that lea to change in medications or urgent interventions in a small fraction of patients.

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    Citation Excerpt :

    We also found that cardiac arrests that occurred in patients on cardiac monitor were associated with better outcomes. The literature provides conflicting data on this issue, with some studies suggesting monitored events are associated with improved outcomes [14–16] and others showing no association [17]. Our results confirm the findings of the majority of studies, suggesting an association between cardiac monitoring and improved outcomes.

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This study was supported by funds from the Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.

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