OUTCOMES OF PATIENTS HOSPITALIZED TO A TELEMETRY UNIT

To describe the clinical course of patients admit ted to a nonintensiv e care telemetry unit and to determine whether telemetry identifies pa tients at risk for transfer to the intensive care unit (ICU), 467 pati ents hospitalized for cardiac monitoring in a nonintensive care teleme try unit were followed until death or discharge. The American College of Cardiology guidelines for telemetry use were applied: 65% of patien ts were class I (monitoring definitely indicated); 33% class II (proba bly Indicated); and 2% class III (not indicated). In 5 patients (1%), telemetry contributed to the decision for a transfer to the ICU. In 46 2 patients, telemetry added no significant information. Thirty-eight p atients (8.1%) were transferred to an ICU: 22 because of cardiac deter ioration and 16 because of noncardiac clinical deterioration. Eighteen percent of patients In class I (95% confidence interval [CI], 14.1 to 22.8), 12% in class II (95% CI, 6.7 to 17), and none in class III (95 % CI, 0 to 26) were transferred to the ICU (p = 0.03). Nine patients d ied (1.9%), 4 with terminal illness. Three patients died while on tele metry: 1 had metastatic lung cancer and 2 died suddenly of cardiac cau ses during initial evaluation on the ward. Telemetry identified the te rminal rhythm in the 3 patients. Patients admitted to a non-ICU monito red ward with ischemic syndromes, heart failure, and arrhythmia rarely deteriorated. Patients who did deteriorate were recognized clinically without appreciable contribution from the monitoring process. It rema ins unproven that heart rhythm monitoring in general practice units im proves patient care.