PathwayA Point-of-Care Algorithm to Guide Proper Device Selection for Ambulatory ElectrocardiographyFarasat, Morteza MD*,†; Sanchez, Jose M. MD*,†; West, J. Jason MD*,†; Burke, Joseph M. MD*,†; Prouse, Andrew F. MD*,†; Gore, M. Odette MD, MSCS*,†; Salame, Gerard A. MD†,‡; Keach, Joseph Walker MD†,‡; Trent, Stacey A. MD, MPH§,¶; Haigney, Mark C. P. MD‖; Hogan, Shea E. MD*,†; Peterson, Pamela N. MD, MSPH*,†; Stauffer, Brian L. MD*,†; Holland, Matthew R. MD*,†; Krantz, Mori J. MD*,†Author Information From the *Department of Medicine, Division of Cardiology, Denver Health and Hospital Authority, Denver, CO †Department of Medicine, University of Colorado School of Medicine, Aurora, CO ‡Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, Denver, CO §Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO ¶Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO ‖Department of Medicine, Division of Cardiology, Uniformed Services University of the Health Sciences, Bethesda, MD. Received for publication January 5, 2021; accepted March 6, 2021. Reprints: Morteza Farasat, MD, Denver Health and Hospital Authority, Department of Medicine, Division of Cardiology, 777 Bannock Street, MC 0960, Denver, CO 80204. E-mail: [email protected] Critical Pathways in Cardiology: September 2021 - Volume 20 - Issue 3 - p 140-142 doi: 10.1097/HPC.0000000000000259 Buy Metrics Abstract In the outpatient setting, ambulatory electrocardiography is the most frequently used diagnostic modality for the evaluation of patients in whom cardiac arrhythmias or conduction abnormalities are suspected. Proper selection of the device type and monitoring duration is critical for optimizing diagnostic yield and cost-effective resource utilization. However, despite guidance from major professional societies, the lack of systematic guidance for proper test selection in many institutions results in the need for repeat testing, which leads to not only increased resource utilization and cost of care, but also suboptimal patient care. To address this unmet need at our own institution, we formed a multidisciplinary panel to develop a concise, yet comprehensive algorithm, incorporating the most common indications for ambulatory electrocardiography, to efficiently guide clinicians to the most appropriate test option for a given clinical scenario, with the goal of maximizing diagnostic yield and optimizing resource utilization. The algorithm was designed as a single-page, color-coded flowchart to be utilized both as a rapid reference guide in printed form, and a decision support tool embedded within the electronic medical records system at the point of order entry. We believe that systematic adoption of this algorithm will optimize diagnostic efficiency, resource utilization, and importantly, patient care and satisfaction. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.