Overuse of Cardiac Monitors May Be Counterproductive

Hospitals are hooking up more and more patients to cardiac monitors in the hope of detecting heart rhythm abnormalities and reducing staffing needs. However, as the monitors proliferate and alarms grow more common, some observers are concerned that health care providers are growing desensitized to them, putting patients at risk, a December 29 article in the Boston Globe explains.

Results from an ongoing study of cardiac monitoring practices in 17 hospitals worldwide published in 2010 in the Journal of Electrocardiology found that 26% of patients being monitored for abnormal heart rhythms did not meet the criteria for monitoring. On the other hand, the study found that just 35% of 339 patients who should have been monitored for ischemia, or reduced blood flow to the heart, were equipped with monitors to detect it. Another study of hospitals in California found that nearly 80% of monitor alarms are caused by events such as a patient coughing or sitting up in bed rather than life-threatening situations.

A nurse involved in the international study reported being in a hospital and hearing “alarm after alarm after alarm. It’s constant and by the end of the day it’s white noise.”

Observers suggest that the push toward monitoring is being driven by the fear of potentially missing a heart problem, which can lead to penalization by insurance companies, and the fact that it is easier to outfit many patients with monitors than to take the time to evaluate each patient and determine whether they need one.

As part of the international study, nurses at half the hospitals are taking an online class on appropriate cardiac monitoring to determine whether this makes a difference. However, doctors are the ones who order monitoring, and they are not taking the classes.