Reliability of arrhythmia detection by coronary care unit nurses utilizing telemetry

The efficacy of arrhythmia detection by Coronary Care (CCU) nurses monitoring patients for 24 hours via telemetry was determined utilizing simultaneous Holter monitoring as a baseline. The medical records of 45 male patients were retrospectively reviewed. A total of 247 significant arrhythmias occurred as documented by Holter Monitoring of which 127 were documented by CCU nurses via telemetry, a 49.4% detection rate. Significant arrythmias were categorized as 1) Sinus (87.8% detected), b) Atrial (26.9& detected), c) Ventricular (38.1% detected), and d) Atrioventricular Block (33.3% detected). A comparison of arrhythmias detected between Holter monitoring and telemetry using paired t-test indicated a p value less than or equal to 0.001. Within the 45 records there were 141 physician requests for arrhythmia detection. Thirty arrhythmias actually occurred and CCU nurses documented 13 of them (43.3% detected). CCU nurses documented 114 arrhythmias which hand not been requested by physician order (50.2% detected), The sample (N=45) was divided into two groups: Group A, subjects who had never been in the CCU (N=23); and Group B subjects who had been admitted in the CCU (N=22) prior to monitoring by telemetry and Holter monitoring. The arrhythmia detection rate for Group A was 50.4% with a detection rate of 48.4% for Group B. These arrhythmias were associated with symptoms recorded by subjects in their log books. CCU nurses documented two of the symptomatic arrhythmias with strip recordings but no symptoms were narrated in the patient record. A total of 275 rhythm strips was representative of 127 significant arrhythmias: 17.5% (N-48) gad the rate narratively documented, 9.1% (N-25) had the rhythm identified in writing, and 0.4% (N=1) had the lead placement identified.