Quality Improvement

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Removing road blocks to ED - improved access to telemetry monitoring

Removing road blocks to ED - improved access to telemetry monitoring

What is telemetry monitoring?

Telemetry monitoring enables remote continuous monitoring of heart rhythms for patients at risk of a heart attack or a heart rhythm abnormality.

What are we trying to achieve?

Value: Better, Best, BrilliantOne of the health targets set by the Ministry of Health for 2012/2013 was to reduce the time patients spend in our emergency departments (ED).

A delay in moving patients out of ED into the wards was due to the lack of telemetry units for remote monitoring.  When units are not available patients have to remain in our ED on fixed monitors. On average telemetry units were not available for 24% of requests.  We also discovered that weekdays were worse than weekends with availability falling as low as 50% on some days.

We wanted to make sure that a telemetry unit was available for at least 95% of all requests.

Buying more telemetry units was not an option ($25,000 each).  We set out to find out how we could use the telemetry units more effectively

What did we find?

  • Lengthy delays between a patient being clinically ready to come off a telemetry unit and the decision being made to remove them.
  • Inappropriate use of telemetry monitoring.
  • Urgent unplanned activity to free some units as they were all being used resulting in short supply.

What have we done?

  • Our Cardiologists developed telemetry on/off criteria i.e. when a patient needs it and when we can safely take it off.
    On-off criteria
  • We developed an electronic referral system. It incorporates the new on/off criteria and is available to our doctors through our patient management system.
    Electronic referral system
  • We trained our staff to use the new process and where to find information they need.

Telemetry systems

  • We developed an escalation process for when telemetry units are in short supply

Escalation process

Did we make a difference?

Telemetry monitoring graph

  • On average, units are now available for 95.3% of requests (goal of 95% achieved).
  • Referrals no longer go missing via the fax machine and anyone can check the referral status on our patient management system.
  • Staff also report improved satisfaction using the electronic referral system over the old fax machine and now receive higher referrals.

Runner-up for poster and winner of "Excellence in clinical care" category for Waitemata Health Excellence Awards 2012