NR 721 Week 6 Tradeoff Analysis Example

Tradeoff Analysis: What the Telemetry Discontinuation Protocol Gained and What It Cost on 5 West, September 2026 to August 2027, Against What Was Expected

Student Name

College of Nursing, Chamberlain University

NR 721: Topics in Healthcare Systems Leadership II

Instructor Name

Month Day, Year

Tradeoff Analysis: What the Telemetry Discontinuation Protocol Gained and What It Cost on 5 West, September 2026 to August 2027, Against What Was Expected

The Period

Both sides of this tradeoff are measured over the same twelve months, September 2026 to August 2027, the first full year of nurse-led telemetry discontinuation on 5 West, a 36-bed medical unit with about 12,350 patient-days a year. The comparison period for the gain is the six months before the protocol, February to July 2026. Everything below has already happened; nothing is projected.

The Gain, Stated First

Telemetry use fell from 41 telemetry days per 100 patient-days before the protocol to an average of 31 across the first year, a difference of 10 per 100. On the unit's volume, that is about 1,235 fewer telemetry days in the year. Alarms at the central monitoring station for 5 West fell from a daily average of 1,190 to 940, about 250 fewer alarms a day, most of them leads-off and artifact alarms that technicians must acknowledge and that nurses must answer. The national monitoring standards describe exactly this pattern, monitoring beyond its indication producing alarms without benefit, as the reason to stop telemetry when its indication has passed (Sandau et al., 2017).

The Costs, in the Same Period

Four costs are already real. Transmitters were lost: 16 in the year, of which 3 were returned by families, a net loss of 13 at $2,350, or $30,550. Nurse time was spent answering reminders: about 9 reminders a day, answered in an observed average of 1.6 minutes, comes to about 88 hours of nursing time in the year. Telemetry was reapplied within 24 hours after 21 of 456 removals, 4.6%, each requiring a new order, a new set of electrodes and about ten minutes of nurse and technician time. And three rapid response calls occurred within 24 hours of a removal; each was reviewed by the unit's safety committee, and none was judged related to the absence of monitoring, though the review cannot rule that out with certainty.

Retrieving the Original Estimate

The proposal approved in July 2026 made four predictions. It expected telemetry days to fall from 41 to 25 per 100 patient-days; they fell to 31. It expected alarms to fall by 30%; they fell by 21%. It expected no change in transmitter losses, which it did not mention at all; losses rose from 2 a year to 16. And it expected each reminder to take about two minutes of nurse time; it took 1.6 minutes on average, partly because about four in ten were answered with a default in seconds. The gain was smaller than promised and one cost was not foreseen at all.

Table 1

Original Expectations Against the First Year's Results

Note. Note. Predictions from the approved proposal; results from the record, the monitoring station log and clinical engineering's asset log.

Units That Do Not Convert

The gain and the costs are in different units, and this analysis does not force them into one. Telemetry days and alarms do not convert cleanly into dollars on this unit: telemetry is not billed separately, the monitoring station is staffed at the same level either way, and the value of 250 fewer alarms a day lies mainly in attention, which has no price in the budget. Transmitter losses and nurse hours do have prices. Converting the gain into dollars through some assumed value of an alarm or a telemetry day would let an exchange rate decide the answer. Instead the analysis states each side in its own terms: about 1,235 fewer telemetry days and 250 fewer alarms a day, bought with about $30,550 in lost equipment, 88 nursing hours and 21 reapplications.

Who Bore Each Side

The gains and costs did not fall on the same people, which matters for whether the trade will be sustained. The fewer alarms fell mostly to the monitor technicians and to nurses on the unit, who answer them; the fewer telemetry days fell to patients, who spend less time attached to leads and boxes. The equipment losses fell on clinical engineering's replacement budget, which is not the unit's, and so went largely unnoticed on 5 West until the asset log made them visible. The extra nurse time fell on whichever nurse was holding the reminder at 07:00, usually the departing night nurse. A trade whose costs land on another department's budget and on the shift least able to absorb them is fragile, because the people paying are not the people seeing the benefit.

How the Result Compares

The protocol's size of effect, a fall of about a quarter in telemetry days, is smaller than the fall reported by a hospital that wrote the same national standards directly into its telemetry order (Dressler et al., 2014). That hospital required an indication and a duration at the point of ordering, so monitoring ended by default; 5 West relies on a reminder that a nurse must act on. The comparison suggests that a stronger default would buy more of the gain than better adherence to a reminder.

The Same-Trade Question

Would the unit make the same trade again, knowing what it knows now? The answer is yes, but not on the same terms. The clinical purpose, ending monitoring that no longer helps patients, was achieved in part and with no detectable harm. The largest cost, lost transmitters, came from a missing step rather than from the protocol's logic, and a return bin and a documentation line, already being installed, should remove most of it. The gain fell short mainly because of the 07:00 reminder and the informal list that grew around it, both of which can be changed. The trade was worth making; it was made with a cost nobody priced and a reminder timed for the wrong moment.

What the Analysis Leaves Open

It leaves open whether the unmonitored hours after removal carry a small risk the three reviewed rapid response calls could not reveal, since a year of one unit's experience is too little to detect a rare harm. Removing a practice that clinicians are used to relying on often raises exactly this worry, and it deserves continued review even when early data are reassuring (Norton & Chambers, 2020). The rapid response review will therefore continue for every call within 24 hours of a removal.

References

Dressler, R., Dryer, M. M., Coletti, C., Mahoney, D., & Doorey, A. J. (2014). Altering overuse of cardiac telemetry in non-intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA Internal Medicine, 174(11), 1852-1854. https://doi.org/10.1001/jamainternmed.2014.4491

Norton, W. E., & Chambers, D. A. (2020). Unpacking the complexities of de-implementing inappropriate health interventions. Implementation Science, 15, Article 2. https://doi.org/10.1186/s13012-019-0960-9

Sandau, K. E., Funk, M., Auerbach, A., Barsness, G. W., Blum, K., Cvach, M., Lampert, R., May, J. L., McDaniel, G. M., Perez, M. V., Sendelbach, S., Sommargren, C. E., & Wang, P. J. (2017). Update to practice standards for electrocardiographic monitoring in hospital settings: A scientific statement from the American Heart Association. Circulation, 136(19), e273-e344. https://doi.org/10.1161/CIR.0000000000000527