Wilmington, Del.-based Christiana Care Health System was able to reduce its mean daily cost for non-intensive care unit cardiac telemetry from $18,971 to $5,772 in less than six months through an effort to eliminate unneeded care, according to a JAMA Internal Medicine study.
In response to a perceived overuse of cardiac telemetry, Christiana Care assembled a team in August 2012 to integrate American Heart Association recommendations into the health system's electronic ordering system. The team redesigned and standardized all telemetry orders within the system, making changes such as removing cardiac telemetry orders from order sets for conditions for which the AHA guidelines didn't support such monitoring. The team also embedded bedside nurse assessment guidelines in the ordering system to promote timely, safe and automatic discontinuation of telemetry. In cases where discontinuation was deemed unsafe, the nurse was required to contact the patient's physician.
After implementing the redesigned telemetry orders in March 2013, the system saw "an immediate and sustained reduction in the mean weekly number of telemetry orders," which fell from 1,032.3 to 593.2. The mean duration of telemetry also fell from 57.8 to 30.9 hours, and the mean daily number of patients monitored with telemetry dropped by 70 percent — from 357.5 to 109.1, according to the study.