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Electronic Order Set May Reduce Inappropriate ECG Monitoring

Findings observed among hospitalized patients not in an intensive care unit

WEDNESDAY, March 6, 2019 (HealthDay News) — Use of electronic order sets is a safe and effective way to enhance appropriate electrocardiographic (ECG) monitoring of hospitalized patients, according to a study published in the March issue of the American Journal of Critical Care.

Sue Sendelbach, Ph.D., retired from the Abbott Northwestern Hospital/Minneapolis Heart Institute/Allina Health in Minnesota, and colleagues evaluated the impact of implementing an electronic order set and optional education component, both based on the American Heart Association practice standards for ECG monitoring, on the occurrence of appropriate monitoring. Appropriateness of monitoring was measured preimplementation and postimplementation among 297 adult patients on medical, surgical, neurological, oncological, and orthopedic patient care units that used remote ECG monitoring in a 627-bed hospital.

The researchers found that implementation of the order set was associated with an increase in appropriate monitoring (48.0 percent preimplementation to 61.2 percent postimplementation). The greatest increase in appropriate ordering was seen among medical residents (30.8 percent preimplementation to 76.5 percent postimplementation). There was no significant increase in adverse patient outcomes, including unexpected transfer to the intensive care unit, death, code blue events, and call for the rapid response team.

“ECG monitoring is often ordered as an extra precaution for patient safety or as a substitute for frequent monitoring of vital signs and not for a specific clinical concern,” a coauthor said in a statement. “Once ECG monitoring is ordered, patients may continue to be monitored even when their condition no longer requires it.”

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