Ordering Telemetry
Background
- Many monitored patients do not have a true indication
- Leads to alarm fatigue, unnecessary workups, and patient discomfort/delirium
- Cost: about $110 per patient per day
- Telemetry is not a substitute for more frequent vital signs
- Discuss on rounds: reassess daily need and indication
- Select “MAY” for transfers off telemetry and showering off telemetry among stable patients without troponin elevation or new arrythmia
Clinical Scenario | Duration |
|---|---|
| Cardiac | |
| ACS | 24-48h |
| Post-MI | 48h after revascularization |
| Vasospastic angina | Until symptoms resolve |
| Any event requiring ICD shocks | Remainder of hospitalization |
| New/unstable atrial tachyarrhythmias | Until stable on medical therapies |
| Chronic AFib w/ recurrence of RVR | Clinical judgement |
| Ventricular tachyarrhythmias | Until definitive therapy |
| Symptomatic bradycardia | Until definitive therapy |
| Decompensated CHF | Until underlying cause treated |
| Procedural | |
| Ablation (regardless of co-morbidities) | 12-24h after procedure |
| Cardiac surgery | 48-72h or until discharge if high risk for decompensation |
| Non-cardiac major surgery in patient with AFib risk factors | Until discharge from step-down or ICU |
| Concussion sedation | Until patient awake, alert, HDS |
| Miscellaneous | |
| Endocarditis | Until clinically stable |
| CVA | 24-48h |
| Electrolyte derangement (K, Mg) | Until normalization |
| Hemodialysis | Clinical judgement |
| Drug overdose | Until free of influence of substance |
Notable non-indications
- Rate-controlled afib + clinically stable
- Chronic PVCs
- ESRD on HD
- PCI for non-ACS indication (e.g. pre-transplant)
- Non-cardiac chest pain
- Patient with AICD admitted for non-cardiac condition, non-cardiac surgery, chronic ratecontrolled AFib
- Nearly all non-cardiac conditions (e.g. undifferentiated sepsis, stable GI bleed, alcohol withdrawal) upon transfer out of ICU