AHRQ Study Finds Increased Patient Loads Affect Telemetry Staff’s Ability To Detect Emergencies

If hospital staff monitor too many heart patients at once, care for patients experiencing serious heart problems might be delayed, according to an AHRQ-funded study. A growing number of at-risk patients are monitored remotely by staff who watch patients’ heart monitors for long hours. While the number of patients being monitored at one time varies among hospitals, a staff member may monitor as many as 72 patients at a time. Response times for different numbers of patients were compared In “Patient Load Effects on Response Time to Critical Arrhythmias in Cardiac Telemetry: A Randomized Trial,” published online with anabstract March 5 in the journal Critical Care Medicine. As the number of patients being monitored increased, response times to critical events were slower. More than 200,000 U.S. hospital patients are treated for cardiac arrest each year. The average survival rate for cardiac arrest is 17 percent. However, with quick and proper medical care, the survival rate approaches 40 percent.

2015 May;43(5):1036-42. doi: 10.1097/CCM.0000000000000923.

Patient load effects on response time to critical arrhythmias in cardiac telemetry: a randomized trial.

Segall N1, Hobbs G, Granger CB, Anderson AE, Bonifacio AS, Taekman JM, Wright MC.

Author information

Abstract

OBJECTIVES:

Remotely monitored patients may be at risk for a delayed response to critical arrhythmias if the telemetry watchers who monitor them are subject to an excessive patient load. There are no guidelines or studies regarding the appropriate number of patients that a single watcher may safely and effectively monitor. Our objective was to determine the impact of increasing the number of patients monitored on response time to simulated cardiac arrest.

DESIGN:

Randomized trial.

SETTING:

Laboratory-based experiment.

SUBJECTS:

Forty-two remote telemetry technicians and nurses from cardiac units.

INTERVENTIONS:

Number of patients monitored in a simulation of cardiac telemetry monitoring work.

MEASUREMENTS AND MAIN RESULTS:

We carried out a study to compare response times to ventricular fibrillation across five patient loads: 16, 24, 32, 40, and 48 patients. The simulation replicated the work of telemetry watchers using a combination of real recorded patient electrocardiogram signals and a simulated patient experiencing ventricular fibrillation. Study participants were assigned to one of the five patient loads and completed a 4-hour monitoring session, during which they performed tasks-including event documentation and phone calls to report events-similar to real monitoring work. When the simulated patient sustained ventricular fibrillation, the time required to report this arrhythmia was recorded. As patientloads increased, there was a statistically significant increase in response times to the ventricular fibrillation. In addition, frequency of failure to meet a response time goal of less than 20 seconds was significantly higher in the 48-patient condition than in all other conditions. Task performance decreased as patient load increased.

CONCLUSIONS:

As participants monitored more patients in a laboratory setting, their performance with respect to recognizing critical and noncritical events declined. This study has implications for the design of remote telemetry work and other patient monitoring tasks in critical and intermediate care units.