How Christiana Care Health System used electronic ordering to reduce unnecessary telemetry by 70%

Incorporating evidence-based guidelines into electronic ordering systems can help reduce unnecessary procedures without sacrificing care quality, according to a study in JAMA Internal Medicine.

Officials at Christiana Care Health System in Wilmington, Del., had suspected cardiac telemetry outside of the intensive care unit was being overused in the health system and made several efforts to reduce its usage, to no avail.

In 2012, the health system changed its electronic order entry system so the option to order cardiac telemetry would not appear unless the patients' condition met use guidelines from the American Heart Association. A physician could circumvent the system and order cardiac telemetry if he or she felt it was warranted, but the additional step was meant to help ensure telemetry was only ordered when necessary.

The study found telemetry orders fell from an average of 1,032 per week to 593 per week and the average telemetry duration fell from 57.8 hours to 30.9 hours. Overall, there was a 70 percent decrease in the average number of patients monitored with cardiac telemetry each day. Patient outcome metrics, including code blues and mortality, remained constant throughout the eight-month study period, implying the decrease in cardiac telemetry had no effect on care quality.

"It is remarkable to achieve such a substantial reduction in the use of this resource without significantly increased adverse outcomes," Nader Najafi, MD, assistant clinical professor at UCSF's Division of Hospital Medicine, wrote in an editorial about the study.

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