Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses
Abstract
The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide ‘best practices’ for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.
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The feasibility of continuous human monitoring of multiple screens is questionable and costly, pulling nurses away from direct patient care and education.
“However, the feasibility of continuous human monitoring of multiple screens is questionable and costly, pulling nurses away from direct patient care and education (Drew et al., 2004).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Drew et al., 2004
In “Use of Dedicated Monitor Watchers” (page not provided), the paper says watching multiple screens is difficult, dedicated watchers are costly, and staff nurses cannot continually watch monitors while providing direct patient care. It does not say monitoring pulls nurses away from patient education; its discussion of education concerns training nurses to use monitoring equipment. (LLM, conf=0.84)
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- Authors
- Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., Macfarlane, P. W., Sommargren, C., Swiryn, S., & Van Hare, G. F.
- Venue
- Circulation
- Published
- 2004-10-26
- Volume
- 110
- Issue
- 17
- Pages
- 2721-2746
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2768866949
- Cited by
- 609
- References
- 161
- Citations by year
- 2026: 26 · 2025: 23 · 2024: 20 · 2023: 24 · 2022: 25 · 2021: 30 · 2020: 27 · 2019: 27 · 2018: 25 · 2017: 36 · 2016: 43 · 2015: 45 · 2014: 36 · 2013: 41 · 2012: 23
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Update notices
- correction (2005-01-25)
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ECG monitoring, arrhythmia detection, QT interval monitoring, myocardial ischemia, QT prolongation, computerized ECG analysis, ECG lead systems, quality improvement, proarrhythmic drugs
- MeSH terms
- Workforce, Arrhythmias, Cardiac, Cardiology, Electrocardiography, Electrodes, Hospitalization, Humans, Long QT Syndrome, Monitoring, Physiologic, Myocardial Ischemia
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