Page 14 - Christiana Care Focus June July 2018

Heart & Vascular Health |
Using resources wisely and effectively:
Three years later, cardiac telemetry improvements endure
It took a crisis to expose an opportunity. In 2012, a malfunction in Christiana Hospital’s cardiac monitoring system forced its staff to scramble to use mobile monitors.
In the wake of the outage, interventional cardiologist Patients who didn’t need telemetry were freed
Andrew Doorey, M.D., FACC, FACCP, had a succinct answer to the question of how many patients on cardiac monitoring actually needed it. “I said, that’s easy; most patients don’t need it,’” Dr. Doorey said.
He was right, and the six-month redesign process
that followed transformed the way that Christiana Care uses heart monitoring, also known as cardiac telemetry. Its success in reducing the unnecessary use of telemetry, applying already established guidelines, led to publication in JAMA Internal Medicine and national recognition, including coverage by national publications, speaking requests and more than 50 teleconference calls with other health systems.
More than recognition, these reforms marked progress toward health care’s Quadruple Aim of better care, better experience of care, lower cost and provider well-being.
“The nurses said, ‘This is overdue.
And we were astounded.”
Andrew Doorey, M.D., FACC, FACCP
from wearing bulky monitors that could unbalance them. Fewer false alarms meant providers, especially nurses, could avoid
frustrating distractions and devote their time to more effective care. And the changes saved millions of dollars in health care costs without resulting in higher rates of mortality or cardiac arrest.
Impact continues today
In 2017, Choosing Wisely, a national initiative of the ABIM Foundation to improve patient care by reduc- ing unnecessary tests and procedures, recognized Christiana Care’s efforts as an example of following through on the campaign’s ideals, writing that the im- plementation “resulted in immediate and sustained decreases in telemetry orders and telemetry duration of 43 percent and 47 percent, respectively.”
In a 2017 update to its practice standards for elec- trocardiographic monitoring, the American Heart Association cited the JAMA study as an example of using its standards to minimize false alarms:
“Others have integrated the AHA practice standards into their electronic ordering system on the basis
of the right indication for the right duration and found no apparent increase in mortality, cardiac arrest, activation of the rapid response team or life- threatening arrhythmias.”
Christiana Care’s patients continue to benefit, and the lessons the health system learned apply to the increasingly urgent effort nationwide to limit unnecessary and expensive care.
“The data show no degradation over the past four years.”
Robert M. Dressler, M.D., MBA
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