Trial of a Best-Practice Alert in the Electronic Medical Record to Reduce Unnecessary Telemetry Monitoring

NCT02529176 | Completed DMC

• 1 other identifier: BPA818
• Study Type: interventional
• Target: 1,021
• Locations: 0 countries
• Sites: N/A

Brief Summary

This is a randomized trial of a best-practice alert delivered via the electronic medical record (Apex) to physicians on the Medicine service at UCSF Medical Center over a six month period. The alert notifies physicians that their order for continuous cardiac monitoring (telemetry) for a given patient has exceeded the duration recommended by national guidelines and offers them the opportunity to discontinue monitoring if they feel it is clinically appropriate. Physicians will be randomized to either receive the BPA or not, with the anticipation that physicians in the intervention arm will discontinue unnecessary telemetry.

Conditions

Arrhythmia

Keywords

telemetry; cardiac monitoring

Outcome Measures

Primary Outcomes (1)

• Duration of cardiac monitoring across all patients cared for by the physicians in the study.

  Over the course of the six month trial

Secondary Outcomes (1)

• Code blue and rapid response rates in the hospital

  During the six month trial period

Study Arms (2)

Best-practice alert

EXPERIMENTAL

Receive the best-practice alert (BPA) during the course of their clinical work in the electronic medical record.

Behavioral: Best-practice alert

No alert

NO INTERVENTION

Physicians will receive no best-practice alert from the electronic medical record.

Interventions

Best-practice alert BEHAVIORAL

The best-practice alert notifies physicians that their patient's telemetry monitoring duration has exceeded national guidelines and gives the physician the option to: discontinue monitoring if they feel it is clinically appropriate, dismiss the alert, or re-alert in four hours.

Also known as: BPA

Best-practice alert

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Resident or attending physician on the Medicine service during the six month trial period.

You may not qualify if:

• None

Sponsors & Collaborators

• University of California, San Francisco: lead

Related Publications (5)

• Estrada CA, Rosman HS, Prasad NK, Battilana G, Alexander M, Held AC, Young MJ. Role of telemetry monitoring in the non-intensive care unit. Am J Cardiol. 1995 Nov 1;76(12):960-5. doi: 10.1016/s0002-9149(99)80270-7.

  PMID: 7484840 BACKGROUND

• Najafi N, Auerbach A. Use and outcomes of telemetry monitoring on a medicine service. Arch Intern Med. 2012 Sep 24;172(17):1349-50. doi: 10.1001/archinternmed.2012.3163. No abstract available.

  PMID: 22892708 BACKGROUND

• Benjamin EM, Klugman RA, Luckmann R, Fairchild DG, Abookire SA. Impact of cardiac telemetry on patient safety and cost. Am J Manag Care. 2013 Jun 1;19(6):e225-32.

  PMID: 23844751 BACKGROUND

• Dressler R, Dryer MM, Coletti C, Mahoney D, Doorey AJ. Altering overuse of cardiac telemetry in non-intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA Intern Med. 2014 Nov;174(11):1852-4. doi: 10.1001/jamainternmed.2014.4491. No abstract available.

  PMID: 25243419 BACKGROUND

• Najafi N, Cucina R, Pierre B, Khanna R. Assessment of a Targeted Electronic Health Record Intervention to Reduce Telemetry Duration: A Cluster-Randomized Clinical Trial. JAMA Intern Med. 2019 Jan 1;179(1):11-15. doi: 10.1001/jamainternmed.2018.5859.

  PMID: 30535345 DERIVED

MeSH Terms

Conditions

Arrhythmias, Cardiac

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Nader Najafi, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Clinical Professor

Study Record Dates

• First Submitted: August 18, 2015
• First Posted: August 20, 2015
• Study Start: December 1, 2016
• Primary Completion: June 1, 2017
• Study Completion: June 1, 2017
• Last Updated: November 14, 2019

Record last verified: 2019-11