What is monitored in a telemetry hospital room?

What is Monitored in a Telemetry Hospital Room

In a telemetry hospital room, continuous cardiac rhythm (heart rate and arrhythmias) is the primary parameter monitored, along with hemodynamic parameters and oxygen saturation when available on networked systems. 1

Core Monitoring Parameters

Cardiac Monitoring

• Heart rhythm and rate - This is the cornerstone of telemetry monitoring, designed specifically for continuous detection of cardiac arrhythmias in patients with cardiovascular conditions or at risk for cardiovascular events 1
• Arrhythmia detection - Modern telemetry systems include sophisticated ECG software capable of identifying various arrhythmia types, including life-threatening ventricular tachycardia and ventricular fibrillation 2
• ST-segment changes - Advanced systems can monitor for myocardial ischemia through continuous ST-segment analysis, though this capability faces significant challenges with false alarms 1, 2
• QT-interval monitoring - Current bedside monitors include software to detect QT-interval prolongation, which is particularly important for patients receiving QT-prolonging medications 1, 2

Additional Physiologic Parameters

• Hemodynamic parameters - When integrated into networked systems, telemetry can display blood pressure (both noninvasive and invasive arterial monitoring) 1
• Oxygen saturation - Pulse oximetry waveforms are commonly transmitted through telemetry systems, though delays of up to 8 seconds and loss of synchronization with ECG have been reported 1
• Respiratory rate - Modern physiologic monitors can track respiratory patterns as part of comprehensive vital sign monitoring 2

System Architecture and Data Flow

How Telemetry Works

• Wireless transmission - Patient ECG signals are acquired through electrodes and lead wires connected to a portable telemetry device that transmits via radio frequencies to ceiling antennae 1
• Central processing - Data is transmitted to a central server and monitor station where it is processed and analyzed 1
• Bedside display - The processed information is sent back to bedside monitors via wired hospital networks 1

Critical Limitation: Display Latency

• Delays of up to 5 seconds for continuous ECG data have been documented between when the rhythm occurs in the patient and when it appears on the bedside monitor 1
• Pulse oximetry delays can reach 8 seconds with potential loss of synchronization to the displayed ECG 1
• These delays are inherent to wireless networked systems due to transmission errors, network load, and server processing time 1

Clinical Applications

Appropriate Use Cases

• Arrhythmia surveillance - Telemetry is reasonable when there is concern for clinical deterioration, in patients with cardiovascular risk factors, or those receiving QT-prolonging medications 1
• Post-acute coronary syndrome - Monitoring is indicated for early-phase ACS (first 24-48 hours) for intermediate to high-risk patients 1
• Post-cardiac procedures - After PCI with complications or suboptimal results, monitoring for at least 24 hours is recommended 1

When Hard-Wired Monitoring is Preferred

• Instantaneous monitoring needs - If situations require real-time data without any delay (such as during certain procedures or critical interventions), hard-wired systems should be used instead of wireless telemetry 1
• This is because the latency in wireless systems may compromise patient safety when instantaneous information is necessary 1

Important Caveats

Alarm Management Challenges

• False and nonactionable alarms represent a serious problem, particularly for ST-segment monitoring where 91% of alarms in one study were considered nonactionable 1
• This has led to alarm fatigue and desensitization of clinicians, which can result in sentinel events 1

Monitoring Limitations

• Not a substitute for clinical assessment - Normal telemetry with stable vital signs in a patient with palpitations typically does not require immediate specialist intervention and can be documented for morning rounds discussion 3
• Diagnostic yield varies - Telemetry has low diagnostic yield in the absence of high suspicion for arrhythmic causes 3