Abstract 11292: Reducing Telemetry Utilization in Hospitalized Comfort Care Patients

Abstract

Introduction: Telemetry overutilization increases costs and interventions that may result in patient harm, particularly at the end of life. ‘Comfort care’ (CC) patients are especially vulnerable to unnecessary telemetry use. Hypothesis: Using provider education and electronic medical record (EMR) modification, we anticipated a reduction in the use of telemetry in hospitalized CC patients at our institution by 25% compared to baseline. Methods: We included inpatient medicine house staff (HS) and physician assistants (PA) teams. We provided education only to HS (a total of 140 providers) on indications for telemetry and proper discontinuation of telemetry orders in the EMR. Subsequently, we modified the CC order set for all providers to simplify telemetry discontinuation in CC patients. We measured the rates of CC patients with active telemetry, correctly discontinued telemetry, and telemetry reordered after discontinuation over time. Results: From October 2020 to April 2022, the median number of CC patients with telemetry orders decreased from 16 to 8 monthly (Figure 1), and telemetry discontinuation improved by 54% on HS and 48% on PA services (Figure 2). HS discontinued telemetry sooner after CC orders were placed compared to PA. 93% of HS and 100% of PA discontinue telemetry orders were placed within 2 hours of CC orders in the intervention period. The rate of reordering telemetry after discontinuation remained unchanged at 4%. Conclusions: In hospitalized CC patients, provider education yielded earlier time to discontinuation of telemetry orders and reductions in telemetry use. EMR modification prompted substantial reductions in telemetry use among both HS and PA teams.

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