Inpatient Electrocardiographic Monitoring is overused and dangerous practice

Electrocardiographic (ECG) monitoring is a common practice used in hospitalized patients, but research suggests much of it is unnecessary, inconvenient, costly, and can be a significant contributor to nurse alarm fatigue and delayed admissions. In fact, the research, published in Cardiovascular Critical Care, March 2019, shows ECG monitoring is more often used as an extra safety net (in lieu of frequent monitoring of vital signs) than it is for a warranted clinical reason. However, when electronic data sets and education is introduced, appropriate use improves measurably.

The study says, “researchers and clinicians have reported overuse of ECG monitoring that was associated with emergency department overcrowding, leaving patients waiting for admission to a telemetry unit bed still occupied by a patient with no clinical indication for monitoring.” Changing this – using ECG only for patients who really need it would, the researchers suggest, reduce the number of false or clinically irrelevant ECG alarms.

The study included 297 adult patients on medical, surgical, neurological, oncological, and orthopedic patient care units that used remote electrocardiographic monitoring in a 627-bed hospital in Minneapolis, MN. Electronic health record of order sets that prompted physicians to order ECG based on the American Heart Association practice standards were developed by a critical care clinical nurse specialist, a nursing professor and staff nurse on a cardiovascular unit, an intensivist with experience creating EHR order sets for providers, and 2 hospitalists with expertise.

All 30 residents received education on the AHA practice standards and use of the order set. The 64 hospitalists received a 1-slide overview of the implementation of the computerized order set but declined the formal education given to the residents. In addition, a quick reference pocket-sized brochure with the practice standards was available to all ordering healthcare providers.

Following the order set increased appropriate monitoring from 48 percent to 61 percent and the largest increase was in ordering by medical residents from 31 percent to 77 percent, with no significant increase in adverse patient outcomes noted. However, among the hospitalists, none of whom completed the formal education, they saw no statistically significant improvement in adherence to the practice standards, whereas medical residents, who received mandatory education, had a statistically significant improvement in ordering compliance.

“Use of electronic order sets is an effective and safe way to enhance appropriate electrocardiographic monitoring,” the authors wrote. “Although education alone does not change practice, our results indicate that education may provide a key element to understanding the rationale for a practice change and may increase adherence to the practice change.”