Utilization of Continuous Cardiac Monitoring on Hospitalist-led Teaching Teams

Abstract

Guidelines for continuous cardiac monitoring (CCM) have focused almost exclusively on cardiac diagnoses, thus limiting their application to a general medical population. In this study, a retrospective chart review was performed to identify the reasons that general medical patients, cared for on hospitalist-led inpatient teaching teams between April 2017 and February 2018, were initiated and maintained on CCM, and to determine the incidence of clinically significant arrhythmias in this patient population. The three most common reasons for telemetry initiation were sepsis (24%), arrhythmias (12%), and hypoxia (10%). Most patients remained on telemetry for more than 48 hours (62%) and a significant number of patients were on telemetry until they were discharged from the hospital (39%). Of the cumulative total of more than 20,573 hours of CCM provided to this patient population, 37% of patients demonstrated only normal sinus rhythm and 3% had a clinically significant arrhythmia that affected management.

Keywords: continuous cardiac monitoring; high value care; hospitalist; telemetry.

Figure 1. Time of day that continuous cardiac monitoring (CCM) was initiated

When patients were cared for by the day team of residents/medical students/ attending hospitalists, 51% of the orders for CCM were placed (22.0% between 7 AM and noon, 29.5% between noon and 7 PM). When most patients were cared for by the overnight residents/supervising hospitalists, 49% of the orders were placed (23.6% between 7 PM and midnight, 24.8% between midnight and 7 AM).