Telemetry Monitoring: Who needs it?

Which of the following patients does not warrant monitoring with telemetry after admission to the hospital?

A. AICD firing
B. Type II and complete heart block
C. Decompensated heart failure
D. Acute cerebrovascular accident
E. Massive blood transfusion
F. All of the above warrant monitoring

…an excerpt from The Kaji Review


Answer: F  
In addition to the above, those with a prolonged QT interval with ventricular arrhythmias and acute coronary syndrome patients warrant monitoring. Non-intensive telemetry units are utilized for monitoring patients at risk for life-threatening dysrhythmias and sudden death. Physicians often use monitored beds for patients who might only require frequent nursing care.

When 70% of the top 10 diseases admitted through the emergency department (ED) are clinically indicated for telemetry, hospitals with limited resources will be overwhelmed.  This causes increased boarding in the ED. There is evidence for monitoring in patients admitted for implantable cardioverter-defibrillator firing, type II and complete atrioventricular block, prolonged QT interval with ventricular arrhythmia, decompensated heart failure, acute cerebrovascular event, acute coronary syndrome, and massive blood transfusion.

Monitoring is beneficial for selected patients with syncope, gastrointestinal hemorrhage, atrial tachyarrhythmias, and uncorrected electrolyte abnormalities. Telemetry is not indicated for patients requiring minor blood transfusions, low risk chest pain patients with normal electrocardiography, and stable patients receiving anticoagulation for pulmonary embolism.

LLSA 2009: Chen EH and Hollander JE. When do patients need admission to a telemetry bed? J Emerg Med. 2007; 33(1): 53-60. full text

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