Practical challenges regarding in-hospital telemetry monitoring require the development of European practice standards

During the past four decades, portable telemetry monitoring has been used for in-hospital detection of arrhythmias in a diverse group of medical and surgical patients. Indeed it is still a cornerstone of care in most critical care settings in order to detect and expedite the treatment of serious cardiac arrhythmias. Telemetry monitoring decreases the need for beds in intensive care units and is also widely used in non-critical care wards. Accordingly, the demand for in-hospital telemetry monitoring has increased beyond capacity in many acute hospital settings, creating patient safety issues. In order to make evidence-based decisions regarding the appropriate use of scarce resources, clinicians require guidance. To meet these challenges, the American College of Cardiology published a practice standard for in-hospital cardiac monitoring to help assess which patients are appropriate for admission to non-critical telemetry beds.1 The guidelines were revised in collaboration with the American Heart Association (AHA) in 2004.2
The AHA practice standards for electrocardiographic monitoring in hospital settings2 classifies patients into three classes: class I (monitoring is indicated in most, if not all patients); class II (monitoring may be of benefit in some patients but is not considered essential for all patients); and class III (monitoring is not indicated). The purpose of the practice standard is to promote patient safety and implement effective telemetry monitoring. However, many practice orientated questions persist in clinical practice and there is an urgent need to update the evidence base that informs clinical practice. Five main challenges in terms of in-hospital telemetry monitoring merit further discussion.