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

Area of Science:

• Healthcare Management
• Clinical Informatics
• Patient Safety

Background:

• Inappropriate continuous cardiac monitoring (CCM) increases hospital resource use and contributes to alarm fatigue, compromising patient safety.
• The American Heart Association (AHA) provides guidelines for selective CCM, aiming to optimize monitoring practices.
• Previous assessments indicated a need for a longitudinal review of selective CCM policy impacts.

Purpose of the Study:

• To evaluate the three-year longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality.
• To assess the effect of nursing re-education on cardiac alarm importance.
• To analyze changes in cardiac monitoring days (CMD) and emergency department (ED) boarding rates.

Main Methods:

• A system-wide selective CCM policy was implemented based on AHA guidelines, stratifying patients into Critical Classes I, II, and III with varying CCM durations.
• Data on CMD, ED boarding rate, mortality, and LOS were collected pre-implementation, post-implementation, and at three-year follow-up.
• Statistical analysis was performed to determine the significance of changes observed.

Main Results:

• A 53.5% decrease in CMD was observed directly after policy implementation, remaining stable at a three-year follow-up (+0.5% increase, p=0.2764).
• No significant changes in mortality rates (slight decrease of 3.1%, p=0.781) or LOS (slight increase of 1.1%, p=0.649) were found.
• A significant increase in ED boarding rate (7.7%, p<0.001) was noted, attributed to other hospital factors.

Conclusions:

• Implementing selective CCM effectively decreases average cardiac monitoring rates.
• The policy is sustainable for reducing hospital resource utilization without adversely affecting LOS or mortality.
• Selective cardiac monitoring allows for more appropriate focus on patient care and safety.