Original Contribution
Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry

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Abstract

Objective

The aim of this study was to determine the prevalence of life-threatening arrhythmias in monitored ED patients while in the radiology suite.

Methods

This is a retrospective analysis at a tertiary care hospital with an ED census of 52 000 visits. The patient population consisted of 3051 adult ED patients with a chief complaint of chest pain, who were monitored with telemetry while they were sent to the radiology suite, and who were ultimately admitted to the hospital.

Results

Of a total of 3051 consecutive patients with a cardiac presentation who received a nonportable chest x-ray, no patients were found to have incurred a life-threatening arrhythmia while in the radiology suite.

Conclusion

The prevalence of a cardiac arrhythmia occurring during transport or while within the radiology suite in our study was zero. We conclude that stable patients can probably be transported to radiology safely without the use of bedside telemetry.

Introduction

Patients with chest pain represent 20% to 30% of all ED admissions [1] and account for 6 to 8 million visits per year [2]. Ninety percent of patients with acute myocardial infarction have a cardiac rhythm abnormality, and 25% have a conduction disturbance. The incidence of a serious arrhythmia, such as ventricular fibrillation, is highest within the first hour after acute myocardial infarction [3]. Thus, patients suspected of acute coronary syndrome are placed on cardiac monitors while in the ED. During temporary absence from the ED, patients are typically placed on telemetry as a precautionary measure. The actual incidence of arrhythmias in patients transported out of the ED for a radiological study is unknown.

Appropriate resource allotment and diagnostic techniques for patients suspected of acute coronary syndrome is especially important, given the sheer numbers of these patients. Substantial evidence has supported the efficacy of coronary care units in treating and preventing cardiac complications since their initial employment for cardiac patients in the 1960s. Coronary care units reduced mortality in the first 6 to 12 hours after an acute myocardial infarction [4]. However, these highly specialized units were also appropriated for many patients who did not incur a cardiac complication. As a result, a more cost-effective [5] and medically appropriate [6] non–intensive care unit cardiac monitoring unit has been added to many hospitals for disposition of low-risk cardiac patients. Using this as an example of the evolution of resource allotment for low-risk cardiac patients, we may then extrapolate this concept to ED telemetry monitoring. Current standard practice is for an ED nurse or technician to escort patients on telemetry to the radiology suite as a precautionary measure. This could change staffing needs, for example, by occupying staff who would otherwise be available to attend to the needs of the remaining patients in the ED or by delaying radiological studies of patients with chest pain.

This study examines how often a cardiac arrhythmia occurred in patients with chest pain while they were receiving a chest x-ray outside the boundaries of the ED. We hypothesized that the incidence of life-threatening arrhythmia would be extremely low. We assumed that if a cardiac patient was clinically unstable, the ED physician would order a portable chest x-ray rather than transport the patient to the radiology suite. We selected patients with a chest complaint as determined by an admitting diagnosis of myocardial infarction, unstable angina, pulmonary embolus, syncope, or chest pain. These specific patients were then selected for our study if they also underwent a nonportable chest x-ray as part of their admission workup. Further, we selected those patients who were admitted to the hospital to include those patients who were more likely to incur an arrhythmia. This study was undertaken to evaluate if telemetry monitoring for radiology transfer can be justified on a patient-safety basis.

Section snippets

Methods

This study is a retrospective explicit chart analysis. The setting is a 500-bed university-based tertiary care level 1 trauma center with an annual ED census of 52 000 visits. The study was reviewed by the institutional review board and considered exempt from written informed consent.

The study population consisted of adult ED patients who presented with chest pain, who were sent to the radiology suite while being monitored by telemetry, and who were ultimately admitted to the hospital. Inclusion

Results

There were no life-threatening arrhythmias (asystole, heart block, ventricular tachycardia, and ventricular fibrillation) that occurred in our population of 3051 consecutive patients. The 95% confidence interval is 0.0000% to 0.0012%.

Limits

We could increase our time period and, thus, our sample size. Additionally, because our patients included those who received only a chest x-ray, patients who were sent to computed tomography or magnetic resonance imaging while being monitored by telemetry were not evaluated in this study. We cannot extrapolate these results to patients receiving computed tomography or magnetic resonance imaging because these patients are outside the ED for longer periods, and an x-ray technician may not always

Discussion

The goal of this study was to determine the prevalence of life-threatening arrhythmias occurring in stable patients transferred to the radiology suite. During our study period, we found that no life-threatening arrhythmias occurred in this patient population while they were in the radiology suite receiving a chest x-ray. We do not feel that excluding discharged patients compromised our results because if such patients did incur a life-threatening arrhythmia, they would have been admitted.

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