Sheryl Williams, MD, FACP, SFHM, MS-HQSM and Ian Jenkins, MD, SFHM

Overview

Mounting evidence shows that the American healthcare system costs too much for the results it achieves in terms of patient outcomes and access. Many different parts of this system need attention, and it can be difficult to know where to begin. However, the inpatient / hospital environment is a “high intensity” healthcare delivery setting, and the “Choosing Wisely” initiative of the American Board of Internal Medicine Foundation (ABIMF) offers a list of low value healthcare practices which make great targets for improvement efforts. In this module, we will tackle one of the top five practices chosen for Choosing Wisely by the Society of Hospital Medicine: continuous telemetry monitoring. 

Objectives

The goal of this module is to review the guideline recommendations and the literature supporting the harms, benefits, and proper utilization of telemetry monitoring. 

Key Points

• Understand why Choosing Wisely recommends not ordering telemetry outside the ICU without using a protocol to govern continuation
• Why successful projects like this must target not only physician ordering behavior, but also hospital processes and departments that influence the targeted measure
• That physicians will choose wisely when you make it easy to do the right thing
• Why a successful project must be a multidisciplinary effort
• Telemetry is not a proxy for closely monitoring a patient
• Inappropriate telemetry use can contribute to well recognized patient harms
• Overuse of telemetry can increase costs, and length of stay and decrease patient satisfaction
• Hospitalists are in a unique position to improve this quality of care issue

Estimated time to complete: 1 hour