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The ACC/AHA practice standards based on expert consensus (not randomized control trials) recommends cardiac monitoring for ischemia, QT interval, Class I, and some Class II patients8. It is not indicated in Class III patients:

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In a separate study, the cost of telemetry monitoring in a non-ICU setting averaged at $41, 690 for 379 telemetry days5. More recent estimates have put this cost at $1400 per patient per 24 hours of telemetry6.

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Another prospective study was performed of 2,240 patients admitted to a telemetry unit over 7 months. Telemetry led to direct modifications in management in 156 patients (7%; 95% confidence interval [CI] 5.9% to 8%). Telemetry was perceived as useful but did not alter management for 127 patients (5.7%; 95% CI 4.7% to 6.6%). There were 20 deaths in the telemetry unit (0.9%; 95% CI 0.5% to 1.3%): 4 of the 20 deaths (i.e 20%) occurred while patients were being monitored. This study suggests the role of telemetry may be overestimated by physicians4.

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The Bottom Line: Cardiac monitoring is indicated for specific patient populations at high risk for life-threatening arrhythmias and should not be used in place of or as an adjunct to close clinical observation.

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Context: Telemetry is often used on patients who do not fit criteria for appropriate use. Limited telemetry beds contribute to increased ED boarding times for admitted patients1. Telemetry monitoring has high false positive rates that result in unnecessary downstream tests and a high incidence of medical staff alarm fatigue2. Monitors also limit patient movement, cause patients and families to focus on the monitor and create significant hospital costs when patients leave with them.

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The Data: A retrospective analysis was performed of 562 patients admitted to a telemetry unit. A total of 1932 monitoring days were evaluated. Using institutionally derived guidelines in part based on ACC/AHA consensus criteria, patients were divided into: “telemetry indicated” and “telemetry not indicated.”  In the “telemetry indicated” group, 34% had a total of 336 arrhythmic events. In contrast, in the “telemetry not indicated” group, only 11% had a total of 53 events (P < 0.001). None of the patients in “telemetry not indicated” group had a clinically significant arrhythmia (P < 0.05)3.

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Q: Should cardiac monitoring be routinely ordered for non-ICU in-patients with concern for clinical deterioration to provide early indication of worsening status?

Conclusion: Telemetry monitoring is useful in patients with clear indications and who have a high risk of arrhythmia. It is often overused due to inappropriate initiation in low risk patients and continuation of monitoring beyond recommended duration of benefit. This monitoring is costly, can lead to unnecessary testing and can affect the patient experience.