Current ECG telemetry practice in the UK: a national audit

Electrocardiographic monitoring by telemetry has become commonplace throughout the UK. This survey was designed to assess its availability, to determine current practice and so to inform future recommendations for optimal telemetry working practice.
Data were collected via postal questionnaire followed by telephone contact. Questionnaires were completed by 280 (99.3%) of the 282 coronary care units (CCUs) contacted. Telemetry is now widely available, with 77.3% of CCUs offering a service, though practice varies widely from unit to unit. Only 15% of telemetry services were supported by written protocols, telemetry duration was routinely set in only 17.4% and interrogation was haphazard, with fewer than 27.2% of units investigating each symptomatic event.
Overall responsibility for the service was unclear, and routine medical input occurred in only 48.6% of services. The task of telemetry monitoring was delegated to relatively junior CCU nursing staff (94% D/E grade). Verbal information was commonly given to patients, but written information was very rare (2.75%). Some 70% obtained no formal patient consent (written or verbal) prior to commencing telemetry. Nonetheless, CCU staff felt strongly that the service was valuable and affected patient care positively.
UK telemetry practice is haphazard, variable and poorly supported by adequate protocols. The potential for missing arrhythmias and/or for mismanaging them is evident, making a strong case for practice guidelines defining the responsibilities of staff involved, identifying best practice and outlining supportive educational requirements.