In addition to patient care, hospitalists are tasked with looking at ways to improve hospital efficiency or patient quality of care. Their target: patient flow. The culprit: inappropriate use of telemetry.<\/span><\/p>\n\u201cAppropriate use of telemetry is an issue many hospitals are experiencing and it is affecting patient flow,\u201d said Rice, director of clinical operations of hospital medicine and medical director of 8N, 8S and the clinical transition unit. \u201cWe have a sense that people are ordering telemetry because they are not confident of the true guidelines or recommendations for its use and once it is ordered, staff forget about it.<\/p>\n
\u201cBasically patients are waiting in the emergency department or in post-anesthesia care unit after surgery because telemetry has been ordered for them but there is no bed available.<\/p>\n
\u201cOur goal in this process is to get people to think more about the true guidelines for ordering telemetry and to think about the parameters to discontinue it. We want to improve the ability of patients to move to a bed and not sit waiting because the resource is not available.\u201d<\/p>\n
Rice said general indications for telemetry focus around heart issues, but it is often ordered for patients who don\u2019t fit the true guidelines. She also noted that telemetry monitoring was exceeding the American College of Cardiology (ACC)-recommended 24-48 hour observation period.<\/p>\n
Her team has begun educating various providers throughout the Medical Center about the updated guidelines, taking steps to place the discontinuation orders under the nursing protocol as well as initiating a change to WizOrder, Vanderbilt\u2019s online computer order entry system.<\/p>\n
\u201cEducation is the biggest piece of this project,\u201d said Rice. \u201cBut another important part is getting the computer to prompt people to do the right thing. The order set needs to ask the right question.\u201d<\/p>\n
The Choosing Wisely team anticipates a move toward an automated electronic notification system that will provide physicians with data from their target service lines. Presently the team is compiling the data and emailing feedback to each physician group involved.<\/p>\n
Although the telemetry project doesn\u2019t fall directly under the Choosing Wisely program, the two initiatives work closely to create a \u201cless is more\u201d health care environment to provide safe and cost effective care to patients.<\/p>\n
The national Choosing Wisely campaign was launched in 2012 with nine medical societies publishing 45 recommendations of tests, treatments and procedures that were deemed overused or wasteful.<\/p>\n
John Held, director of communications for the ABIM Foundation, said the campaign has grown to more than 70 societies with more than 325 recommendations and additional members of the team including the American Dental Association, American Academy of Nursing and the American Physical Therapy Association.<\/p>\n
\u201cThe goal of Choosing Wisely was to spark conversations about waste and overuse,\u201d said Held. \u201cThere is a growing body of literature that seems to show progress is being made in this area.<\/p>\n
\u201cThe work at Vanderbilt is a prime example of what we were hoping would come from Choosing Wisely,\u201d he said. \u201cThere is still much work to be done to address waste and overuse and we\u2019re hopeful the campaign is embraced and implemented in care settings across the country.\u201d<\/p>\n
Iams said that his group has fielded inquiries from other centers with sights on implementing similar campaigns at their institutions. Vanderbilt\u2019s group also recently participated in a case study supported by the Association of American Medical Colleges (AAMC) as well as presented at AAMC meetings to help make future initiatives more efficient at other academic medical centers.<\/p>\n
\u201cWe are really trying to talk to as many people as we can to help support the efforts and provide as much direction or input as possible,\u201d said Iams. \u201cEach institution approaches these initiatives in different ways so having any level of feedback seems to be helpful.<\/p>\n
\u201cAt Vanderbilt, we want to create a rapid way for the initiative to stick in people\u2019s minds. We don\u2019t want to experience success in one area, and that\u2019s it. We want to feed off the impact that Choosing Wisely labs have had and utilize what we have learned as we move on to the next area of overutilization.\u201d<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
The U.S. medical system spends $750 billion a year on health care that doesn\u2019t result in improved health outcomes. In fact, one-third of medical spending is wasted on unnecessary procedures, according to a report from the Institute of Medicine. Patients sometimes ask for tests and treatments that are not necessarily in their best interest. And…<\/p>\n","protected":false},"author":220,"featured_media":615,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_links_to":"","_links_to_target":""},"categories":[14,29],"tags":[],"class_list":["post-390","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vm-features","category-vm-winter-2015"],"acf":[],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/cdn.vanderbilt.edu\/t2-main\/medschool-prd\/wp-content\/uploads\/sites\/82\/2015\/02\/choosingwisely.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pcDnub-6i","_links":{"self":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/390","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/users\/220"}],"replies":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/comments?post=390"}],"version-history":[{"count":1,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/390\/revisions"}],"predecessor-version":[{"id":3181,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/390\/revisions\/3181"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/media\/615"}],"wp:attachment":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/media?parent=390"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/categories?post=390"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/tags?post=390"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![\"graph\"](\"http:\/\/www.mc.vanderbilt.edu\/vanderbiltmedicine\/wp-content\/uploads\/sites\/7\/2015\/02\/graph.jpg\")
<\/a>