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E-HeaRT BPA: electronic health record telemetry BPA
  1. Kuo-Kai Chin1,
  2. David Svec2,
  3. Benjamin Leung3,
  4. Christopher Sharp2,
  5. Lisa Shieh2
  1. 1Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  2. 2Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  3. 3Stanford Healthcare, Stanford, California, USA
  1. Correspondence to Dr Lisa Shieh, Medicine, Stanford School of Medicine, Stanford, CA 94305, USA; lshieh{at}


Introduction Continuous cardiac monitoring in non-critical care settings is expensive and overutilised. As such, it is an important target of hospital interventions to establish cost-effective, high-quality care. Since inappropriate telemetry use was persistently elevated at our institution, we devised an electronic best practice alert (BPA) and tested it in a randomised controlled fashion.

Methods Between 4 March 2018 and 5 July 2018 at our 600-bed academic hospital, all non-critical care patients who had at least one telemetry order were randomised to the control or intervention group. The intervention group received daily BPAs if telemetry was active.

Results 275 and 283 patients were randomised to the intervention and control groups, respectively. The intervention group triggered 1042 alerts and trended toward fewer telemetry days (3.8 vs 5.0, p=0.017). The intervention group stopped telemetry 31.7% of the alerted patient-days compared with 23.3% for the control group (OR 1.53, 95% CI 1.24 to 1.88, p<0.001). There were no significant differences in length of stay, rapid responses, code blues, or mortality between the two groups.

Conclusions Using a randomised controlled design, we show that BPAs significantly reduce telemetry without negatively affecting patient outcomes. They should have a role in promoting high-value telemetry use.

  • cardiology
  • health informatics
  • quality in health care

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  • Contributors LS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: LS, DS, CS, BL. Acquisition, analysis, or interpretation of data: KC, LS, DS, CS, BL. Drafting of the manuscript: KC. Critical revision of the manuscript for important intellectual content: KC, LS, DS, CS, BL. Statistical analysis: KC. Study supervision: LS, DS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board and informed consent was waived.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request

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