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Empowering Nurses and Residents to Improve Telemetry Stewardship in the Academic Care Setting
  • +5
  • Eamon Duffy,
  • Timothy Niessen,
  • Keisha Perrin,
  • Ariella Apfel,
  • Amanda Bertram,
  • Sara Keller,
  • Leonard Feldman,
  • Amit Pahwa
Eamon Duffy
Johns Hopkins Hospital
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Timothy Niessen
Johns Hopkins
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Keisha Perrin
Johns Hopkins Hospital
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Ariella Apfel
Johns Hopkins University School of Medicine
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Amanda Bertram
Johns Hopkins Medicine
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Sara Keller
Johns Hopkins Medicine
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Leonard Feldman
Johns Hopkins University School of Medicine
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Amit Pahwa
Johns Hopkins Medicine
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Peer review status:IN REVISION

18 Apr 2020Submitted to Journal of Evaluation in Clinical Practice
22 Apr 2020Assigned to Editor
22 Apr 2020Submission Checks Completed
24 Apr 2020Reviewer(s) Assigned
11 Jun 2020Review(s) Completed, Editorial Evaluation Pending
11 Jun 2020Editorial Decision: Revise Minor

Abstract

Inappropriate use of telemetry frequently occurs in the inpatient, non-intensive care unit setting. Recent telemetry practice standards have attempted to guide appropriate use and limit the overuse of this important resource, with limited success. Clinical-effectiveness studies of these practice standards have thus far not included care settings in which resident-physicians are the primary caregivers. Furthermore, studies of the role of nurses in appropriate telemetry use are lacking. In this report, we describe two interventions implemented on general internal medicine units of a large academic hospital over three years. The first intervention, or nurse-discontinuation protocol, allowed nurses to trigger the discontinuation of telemetry once the appropriate duration had passed according to practice standards. The second intervention, or physician-discontinuation protocol, instituted a Best Practice Advisory that notified the resident-physician via the electronic medical record when the appropriate telemetry duration for each patient had elapsed and suggested termination of telemetry. Results showed that the nurse-discontinuation protocol reduced mean patient time on telemetry and the physician-discontinuation protocol reduced mean telemetry orders per patient. These findings validate a prior study and expand on our understanding of telemetry use in the academic care setting in which trainees serve as the primary caregivers.