Reducing telemetry overuse by improving med-surg monitoring

May 28, 2019
By Michael Maylahn

Forget hospitals for a minute.
Instead imagine two bookshops, their teetering shelves lined with dog-eared paperbacks. The first shop is neatly divided by genre and categorized by author. Bookshop Two operates on more lenient guidelines, encouraging staff to place books wherever feels right. Soon Macbeth is in the Children’s section, Nancy Drew has been missing for a week, and no one is quite sure who to blame.

Today's hospital bears an uncanny resemblance to Bookshop Two. Rather than using diagnoses to assign patients to wards, physicians place them in the unit that feels right. The trouble with this model is that it results in extensive patient misfiling, which reduces quality of care, while raising costs.

Current estimates suggest that nearly 37 percent of telemetry patients actually belong in med-surg. This misclassification is largely a product of the fact that physicians, trained to prefer catch-all care, believe telemetry offers better treatment. Though their patients might not actually qualify for continuous monitoring, clinicians choose to send them to telemetry. However, rather than improving patient outcomes, this misclassification aggravates operational inefficiencies and reduces profit margins.

Triaging protocols, such as the AHA's “ECG Practice Standard,” often take the fall for patient-misfiling. However, studies have proven these guidelines are capable of reducing telemetry overuse by 70 percent – suggesting that misfiling has a different root cause. To trace this source, it’s helpful to examine the differences between telemetry and med-surg. Telemetry has a higher nurse to patient ratio, and a central monitoring station where patients receive continuous monitoring and constant care. Conversely, nurses in med-surg collect vitals, on average once every four to six hours. This operational difference causes physicians to reflexively avoid sending their patients to med-surg. In short, ward mistrust translates to patient misclassification.

This mistrust theory is supported by surveys. Only 22 percent of physicians cite arrhythmia monitoring as their primary reason for sending patients to telemetry. In contrast, over 50 percent choose telemetry because they want to “detect deterioration early.” This implies that physicians send their patients to telemetry because they think they’ll receive better care, rather than because they need continuous monitoring.

So why all this mistrust of med-surg? It boils down to the quality of patient monitoring. Med-surg’s spot-check monitors fail to provide a complete picture of a patient’s health, causing clinicians to miss signs of an impending patient crash.

Smart health technology offers the opportunity to renew clinical trust in Med-Surg. These devices can easily convert manually monitored beds to continuously monitored beds, allowing hospitals to provide telemetry-level care in med-surg. Smart monitors deliver AI-power and predictive insights, giving the clinical team the data needed to identify at-risk patients. Furthermore, unlike other monitoring systems, this technology can be rapidly deployed, requiring no large capital investments or infrastructure changes.

But all this poses a question: is the current system – with all its misfiling – really that bad? Yes, because telemetry overuse is not an isolated problem. In fact, it largely contributes to the cross-country epidemic of ED congestion and diversion. When telemetry is at-capacity, patients are forced to “board” in the ER – often staying in hallways for multiple hours before being transferred to inpatient units. Overcrowded ERs have reduced quality of care, and the resulting chaos (patient beds lining hallways, towering stacks of hospital-issued food, and too many worried family members) can take a toll on patient well-being. By improving physician trust in med-surg, smart monitors have the capacity to reduce telemetry overuse and ED-overcrowding, thus improving patient throughput.

The current model has a number of other side effects, including nurse burnout. Studies show that nearly 70 percent of nurses feel overworked, and another 50 percent have considered leaving their jobs. While it’s difficult to pinpoint a single cause of burnout, med-surg inefficiencies play into nurse stress. Currently, med-surg nurses are assigned to more patients than they can handle, and spend a large portion of their shifts spot-checking vitals. While draining their time, this manual monitoring provides little useful information – simply compounding nurse stress. AI-powered devices could alleviate this issue by generating real-time vitals data and critical trends. This, in turn, would reduce nurse burdens and alleviate widespread burnout, allowing them to refocus on patient care.

In addition to its steep clinical implications, telemetry overuse bears a hefty price tag. In an attempt to cut costs while maintaining care-quality, Delaware’s Christiana Care system hardwired the AHA’s guidelines into their tele-ordering service. This implementation was extremely successful, significantly reducing tele-overuse without compromising patient care. Post-hardwiring, telemetry’s mean daily cost plummeted, falling from $18,971 to $5,772. Christiana Care shows that reducing tele-overuse frees up capital, allowing hospitals to invest in better technology and improve staffing.

Michael Maylahn
Telemetry is the hospital’s biggest blocked artery, pulsing with patients and beeping monitors. The consequences of tele-overuse are manifold, including ED congestion, nurse burnout, and a steep financial toll. To reduce this overuse, med-surg must regain physician trust and improve monitoring, while reducing nurse burdens. Smart monitors present an ideal solution, mitigating med-surg inefficiencies by generating predictive trends and offering critical vitals data. If hospitals don't proactively invest in renewing clinical faith, they put their survival at risk – much like Bookshop Number Two.

About the author: Michael Maylahn is the president and founder of Stasis Labs.