Introduction ECG monitoring has been and remains to be an integral part of patient care in hospital. Arrhythmia detection has been reported to affect the clinical management in around 3.4–12.7% of patients. The American Heart association in collaboration with the American College of Cardiology published a statement in 2004 addressing the use of non-intensive cardiac telemetries stratifying patients into 3 different categories: cardiac telemetry is indicated, may provide benefit, or is unlikely to provide benefit. 123 telemetry beds were requested for acute admissions in October, including 13 post lysis stroke patients costing more than 30000 GBP

Methods We have adapted the AHA recommendations and formulated a local telemetry protocol in Causeway. Copies of the adapted guidelines were incorporated in the medical admission booklets, and circulated among the nurses as well as the bed managers. Junior doctors were trained about the protocol. There were 2 parts for this project. Part 1 was aimed at reducing the number of inappropriate cardiac monitors being used, while part 2 was aimed at reducing the duration in which cardiac monitors were used for.

Results Among the admissions, around 30% of referrals were inappropriate and not indicated. Looking into the financial aspect of it, each bed costs around 300 GBP per night, leading to a total of around 30000 GBP for the total admission per night. After launching the cardiac telemetry protocol, there were a total of 89 telemetry bed requests, of which only 3% were inappropriate or not indicated, and an overall reduction of 10% in all the admissions, and 26% reduction in the inappropriate referrals. There was an overall 28% reduction of cost, saving around 10000 GBP during the first month period.

Conclusion Telemetry monitoring requires both trained personnel and specialized equipment, thus making one of the most costly equipment in the hospital setting. Guidelines remain a tool to aid but not replace clinical judgment.