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Health care expenditures are growing at an unsustainable rate with one third of those expenditures directly attributed to overtreatment and waste. Waste associated with unnecessary telemetry utilization includes physical waste in garbage, process defects in false alarms, time in patient flow, motion in tasks, excessive work, and excessive cost. The American Heart Association (AHA) has published guidelines establishing best practices for telemetry use. American Board of Internal Medicine Foundation (ABIMF) and the Society of Hospital Medicine in the Choosing Wisely® campaign have deemed inappropriate telemetry use as a wasteful practice. A multidisciplinary task force was created at Hospital A to design and implement a telemetry utilization protocol to reduce inappropriate telemetry use. Using a systems-based approach, the task force embedded forced-function indication-based telemetry orders into computerized provider order entry (CPOE), and a nurse-driven discontinuation protocol into the hospital’s electronic medical records (EMR). A reduction of 44% was achieved within six months of protocol implementation, reducing the average percentage of patient days with telemetry from 62% to as sustained rate of 35% with no change in the number of Code Blue or RRT activations. The results of this improvement project show that establishing a protocol for telemetry utilization can safely, effectively, and efficiently decrease inappropriate use and telemetry associated waste.



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