**Introduction/Hypothesis**
The initial intent of telemetry monitoring was to help detect life-threatening arrhythmias. However, it is now on the Choosing Wisely Campaign’s Top 12 list of overly used tests/procedures that pertain to excess waste and financial burden on the healthcare system and unnecessary cost incurred by patients. For this reason, the American College of Cardiology (ACC) and American Heart Association (AHA) set guidelines (2004) based on three classes of risk, which differentiates indication of use. Despite these recommendations, telemetry orders are placed at continuous or recurrent frequencies without an appropriate indication.  Financially, at Wellstar Kennestone, the gross cost of telemetry is $7072 per patient per day. When adding up all the non-indicated days of telemetry use, it can be costly and unnecessary for both the patient and the health system. The purpose of our study is to compare the effectiveness of implementing a standardized order set in our health system that is built around physician decision-making based on discrete diagnosis with time automation.  We hypothesized that the intervention would reduce the amount and duration of telemetry use and thus the overall cost.

**Methods**
This is a Plan-Do-Study-Act study design involving Wellstar Kennestone Hospital in Georgia from March 2022 to November 2022. The new order set was implemented July 2022. Patients were 18 years or older in either inpatient or observation status that exclude hospice, obstetrics, pediatrics, NICU, nursery, behavioral health, inpatient rehab, skilled nursing, women’s service, long term acute care, emergency department, and procedural care. The outcomes measured were percent of patient census on telemetry.

**Results**
On a monthly average, 7965 patients were on telemetry from March to June 2022 compared to monthly average of 5320, which is a reduction of 2645 patients (about 33%) after the intervention. This correlates to average percentage of patients on telemetry of 54.6% as pre-intervention compared to 45.8% post-intervention.

**Conclusion**
Telemetry was developed for close monitoring of cardiac arrhythmias, but it comes at a cost. Although the ACC/AHA criteria have listed appropriate indications for telemetry use, unnecessary and non-indicated usage, especially if continuous, can be financially burdensome. For this reason, the Wellstar Kennestone initiated a simplified order set based on physician clinical decision-making for discrete diagnosis to help reduce the use and duration of telemetry, thus making it cost-effective for both the patient and the health system. From a financial aspect, a reduction of 2645 patients using telemetry as mentioned in the results, at a cost of $7072 of telemetry per patient per day, is equivalent to saving the hospital system $18,705,440 during a 4-month time span.



Standardized Order Set Cuts Down Cost of Unnecessary Telemetry Use