Reducing Telemetry Monitoring Duration for Uncomplicated Acute Coronary Syndrome Patients in the Inpatient Setting.

Cardiovascular disease remains the highest cause of death in Ireland. Telemetry monitoring is a valued inpatient diagnostic and surveillance tool. Telemetry monitoring is intended to identify life threatening arrhythmias, ischaemia and QT prolongation. Data collected for this study revealed that the highest user of the inpatient telemetry monitoring service was acute coronary syndrome(ACS)patients. On further analysis, ACS patients were found to be monitored one and a half to over twice the recommended American Heart Association standards of 12-48 hours. This quality improvement project plan focuses on reducing the number of hours that uncomplicated ACS patients are on telemetry monitoring. Using quality improvement strategies such as the Lean Six Sigma and the DMAIC framework as well as other quality improvement tools, a reduction in telemetry monitoring duration for uncomplicated ACS patients was proposed. ACS patients should be discontinued from telemetry monitoring after 48 hours if the patient is stable and is not complicated by arrhythmias or patient deterioration. Dissemination of the proposed improvement could be completed by updating the current telemetry request form. In addition, a summary poster of the 2017 AHA standards could be made available in the CCU for the cardiology team members to reference. The cardiology team members would be provided with education sessions informing them of the proposed change. The proposed plan intends to reduce the number of hours that uncomplicated ACS patients are monitored unnecessarily. As a result, this would improve the efficiency of the telemetry service and help to accommodate new admissions. This could reduce the emergency department waiting time for a monitored bed.