Telemetry Standby: Potential Danger

California law requires hospitals to report certain events to the Department of Public Health, which may issue administrative penalties in certain cases. The California Hospital Association maintains a database of those reports that elicited a penalty. CHA members can access the database at

One recent report involved a delay in detection of an arrhythmia on a monitored patient due to the equipment being in standby mode. In this telemetry unit, like many others, there was a central station without bedside displays.

The system’s design makes communication to the telemetry technician of a patient’s current status (e.g., “away for a scan”) critical. As one manufacturer’s manual states: “Standby suspends monitoring, and you won’t get any waveforms or alarms.” If the technician does not know that a patient has returned from a procedure or that a new patient has been admitted to a previously empty “standby” bed, the lack of central monitoring could be undetected by both the nurse and the technician.

CHPSO suggests that hospitals assess whether their telemetry system has a similar vulnerability. In this particular report, the hospital responded to the issue by putting in place a structured communication protocol to improve communication reliability and reduce the risk of an unmonitored event.

In their protocol:

  • Guidelines identify specific criteria for being placed in the standby mode, which includes who notifies the technician when patient leaves and returns to unit and for a documented projected return time.
  • The telemetry technician will contact the assigned nurse to determine the location and status of the patient if the patient does not return by the projected time.
  • When handing off to the next telemetry technician, the technicians will validate the patients who are on telemetry and who are off for procedures and their projected return time.