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.