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Continuous Cardiac Monitoring Policy Implementation: Three-year Sustained Decrease of Hospital Resource Utilization

Chelsea R. Horwood MD, MPH a
Susan D. Moffatt-Bruce MD, PhD b
Michael F. Rayo PhD c
aDepartment of Surgery, The Ohio State University Wexner Medical Center, USA,
bDepartment of Surgery and Quality and Operations, The Ohio State University Wexner Medical Center, USA,
cDepartment of Integrated Systems Engineering, The Ohio State University, USA,

Structural Approaches to Address Issues in Patient Safety

ISBN: 978-1-83867-085-6, eISBN: 978-1-83867-084-9

Publication date: 24 October 2019

Abstract

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

Keywords

Acknowledgements

Acknowledgments

This research was supported by the Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS) at The Ohio State University, which is sponsored by the Agency for Healthcare Research & Quality (P30HS024379). The authors’ views do not necessarily represent the views of AHRQ.

Citation

Horwood, C.R., Moffatt-Bruce, S.D. and Rayo, M.F. (2019), "Continuous Cardiac Monitoring Policy Implementation: Three-year Sustained Decrease of Hospital Resource Utilization", Structural Approaches to Address Issues in Patient Safety (Advances in Health Care Management, Vol. 18), Emerald Publishing Limited, Leeds, pp. 159-171. https://doi.org/10.1108/S1474-823120190000018007

Publisher

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Emerald Publishing Limited

Copyright © 2019 Emerald Publishing Limited

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