Telemetry Discontinuation Readiness Review App

Suggested Telemetry Discontinuation

How it Works

After configuration, SafeNSound will use the documented information to evaluate the patient's indication for cardiac monitoring (per AHA recommendation), the length of time on monitor, heart rate, blood pressure, and rhythm interpretation.  If the patient has met all the policy rules for telemetry discontinuation, a green checkmark will appear on the Clinical Insights - Daily Rounding Report, indicating that the patient has met all previously established criteria to suggest reviewing the patient's record for possible discontinuation of monitoring. 

Implementation

Implementation is a a several step process that involves not only a technical configuration but also clinical workflow changes.  Change management will be of the utmost importance. We recommend implementing this feature is 3 phases and after your initial go-live with SafeNSound. 

Phase 1 - Decision Making and System Configuration (2-6 weeks)

In phase 1, customers will make decisions around heart rate and blood pressure limits, allowed rhythm interpretations, and ICD-10 diagnosis codes.  The Spacelabs technical team will work with customers to configure the system as per customer decisions, including the interface of the patient diagnoses.

Phase 2 - Data Validation, Benchmarking, and Education (2 months)

In the second phase, we partner with the customer to validate the data that we are receiving for customers and that it matches expectations.  During this phase, workflow changes should be solidified and team education regarding the process changes should occur.  Also during this phase, baseline data should be collected/documented around utilization and length of monitoring (LOM). 

Phase 3 - Go-Live (1-2 weeks)

This phase should involve customer-led support for the process change.  Spacelabs will develop a plan, in conjunction with the customer to ensure adequate access to technical resources for any questions or issues.

Patient Diagnosis Entry: Ensure the patient's diagnosis is accurately entered into the patient record. This information is vital in determining the duration of telemetry monitoring required. Diagnosis information can be manually entered on the patient details window.

You can take advantage of your existing physician workflows for diagnosis entry.  We recommend part of the workflow analysis process is to ensure that diagnoses are entered in a timely fashion.  We recommend partnering a physician champion with the Spacelabs team. 

The diagnosis determines how long the patient is Intended to be monitored, such as 24 hours (Class III), 48 hours (Class II), or continuous (Class I), in line with the American Heart Association guidelines for cardiac monitoring. However, these categories are only clinical suggestions and must be designated based on the facility’s preferences and policies. 

Clinical Insights: Discharge policy column In Daily Rounding shows a green check mark if the patient has met all rules for discontinuation.

 

To Enable Telemetry Discontinuation

Telemetry Discontinuation Readiness Review is accessible in the App Store under Workflow. To enable it, select the toggle on the top right.

To Edit Telemetry Discontinuation Criteria

1. Click on the Telemetry Discontinuation App and edit details.
2. When finished select save.
3. To edit Class I, II, III refer to the charts in the subsections below.

To Edit Diagnostic Codes

Click on Administrator --> Settings  --> Diagnostic Codes

Codes can be added using the plus button

Codes can be removed using the X

Recommended Defaults

Detail Tab

Only Allowed Rhythm Interpretation	Sinus Rhythm, Atrial Fibrillation
24 hours Heart Rate < Than	120
24 hours Systolic BP > Than	90

 

Class Tabs - Sample Policy with ICD-10 codes

Class I

A class I diagnosis requires a physician order for discontinuation of monitoring. The diagnoses specified place the patient in the following category.

Diagnosis	ICD-10
Acute Coronary Syndrome	I24.9
Myocardial Infarction	I21.9
Coronary Artery Disease	I25.1
Vasospastic Angina	I20.1
Cardiac Syncope	R55
Stress Cardiomyopathy	I51.81
ST Elevation/STEMI	I21.01
Post Open Heart Surgery	Z48.812
Left Ventricular Failure	I50.1
Post Trans-Catheter Intervention	Z95.2
Post Resuscitation from Cardiac Arrest	I46.9
Acute Dysrhythmia	I45.9
Symptomatic Bradycardia	R00.1
2nd Degree Block, Type 1 & 2	I44.1
3rd Degree Block	I44.2
Wolff-Parkinson-White Syndrome	I45.6
Acute Decompensated Heart Failure	I50.9
ICD Shocks, Requiring Hospital Admission	Z45.02
Temporary Pacemaker	Z45.018
Permanent Pacemaker Implantation	Z95.0
Stroke	I63.9
Severe Electrolyte Imbalance	E87.8
Drug Overdose	T50.901A

Class II

If no event occurs, a Class II diagnosis usually discontinues monitoring after 48 hours. The diagnoses specified places the patient in the following category:

Diagnosis	ICD-10
Symptomatic Atrial Fibrillation	I48.91
Ventricular Tachycardia	I47.2
Infective Endocarditis	I33.0
Severe Sepsis	R65.21
Cardiac Ablation	Z86.79
Hemodialysis	Z99.0
Pulmonary Embolism	I26

Class III

If no event occurs, a Class III diagnosis usually discontinues monitoring after 24 hours. The diagnoses specified place the patient in the following category:

Diagnosis	ICD-10
Acute Coronary Syndrome	I24.9
Coronary Angioplasty	Z98.61
Low-risk and Non-Cardiac Chest Pain	R07.89
Asymptomatic Bradycardia	R00.1
GI Bleed	K92.2
Alcohol Withdrawal	F10.239
COPD	J44.9

 

Sample Physician Notification Policy

• RN will notify the Physician based on the following parameters/standards unless otherwise ordered.
  • Sinus Node Dysfunction:
  • Symptomatic bradycardia
  • Asymptomatic bradycardia < 50bpm
• Heart block (with or without symptoms)
  • Third-degree AV-block
  • Second—degree AV block (Type I or Type II)
  • Any block including First-degree AV-block. in patients with history of muscular dystrophy
• Pauses:
  • If underlying rhythm is sinus: 3 seconds
  • If underlying rhythm is AFIb I Aflutter. 5 seconds
• Abnormal intervals:
  • New bundle-branch block
  • QT > 500ms (when ordered to measure per physician)
• Premature Ventricular Beats/Non- sustained ventricular tachycardia
  • Symptomatic
  • Ventricular Run > 10 seconds or > 20 ventricular beats per minute
• Supraventricular tachycardia (SVT and/m a-fib)
  • Symptomatic
  • Any new a-fib / a-flutter
  • Non a-fib SVT > 30 seconds with or without symptoms