Abstract 361: Clinical Utility and Impact of Revised Continuous Cardiac Telemetry in Identifying Life Threatening Arrhythmias

Abstract

Background: Continuous cardiac telemetry (CCT) is used to provide immediate awareness of life-threatening rhythm disorders. When used too widely, many patients (pts) who do not need CCT receive this service, while when used too restrictively; this may place pts at risk.

Methods: In March 2013, Christiana Care Health System revised CCT utilization standards based on risk stratification per 2004 AHA guidelines. We retrospectively and randomly examined daily call logs from central monitoring department (CMD) for 2625 monitored non-ICU pts during two separate months, November 2012 (old system, 1323 pts) and June 2013 (new system, 1322 pts). The calls were categorized as emergent (EC) and non EC as per pre-determined criteria. Life-threatening rhythms were defined as sustained ventricular tachycardia/fibrillation and asystole.

Results: The revised CCT system reduced total number of monitored pts by 23% and total no of calls by 44% over a 30 day period. EC frequency was 1.1% for the entire study. There was a single potentially life threatening arrhythmia among the 7200 calls from 2645 pts (ventricular tachycardia that self-terminated in 32 seconds). Only 14% of total EC led to a change in management within 1 hour.

Conclusion: In these non-ICU patients, it was rare that CCT provided an alert to a life-threatening arrhythmia. Arrhythmias leading to treatment changes within 1 hour were also uncommon. Guideline driven use of CCT decreases the overuse of monitors. Low rate of truly emergent arrhythmias in contemporarily managed patients reveals this to be safe.