Which patients need to be on a tele monitor?

Tele monitors are a limited resource both in the ED and on the floor. If we over use them when not absolutely necessary, this can be a serious blow to ED throughput and optimal patient care.

So who really needs a monitor? According to review article by Esther Chen and Judd Hollander, the following types of patients should be hooked up to a tele box:

• automatic defibrillator has fired


• 2nd and 3rd degree AV block


• prolonged QT interval (>450 in women and > 430 in men)


• CHF exacerbation


• acute stroke


• ACS


• massive blood transfusion (> 10 units pRBCs)


• syncope


• atrial arrhythmias receiving therapy for rate or rhythm control


• disorders of potassium, calcium and magnesium

Chen and Hollander suggest that the following patients can do without:

• non-massive blood transfusion (< 10 units pRBCs)


• chest pain patients with an initial normal or non-specific ECG and normal cardiac markers


• COPD exacerbation


• stable patients with PE

Agree?

Source

Chen, Esther and Hollander, Judd. "When do patients need admission to a telemetry bed?" Journal of Emergency Medicine v 33. Jan 2007. pp. 53-60.