OBJECTIVES: To assess the appropriateness of telemetry utilization policy, assess compliance with the telemetry utilization guidelines and assess the effect of telemetry findings on physician practice METHODS: All new admissions to the telemetry unit were prospectively studied over a two-month period. Data collected was entered into Microsoft excel database and imported into Epi info for statistical analysis. Patients were followed for their entire telemetry stay. The appropriateness of admission and subsequent stay were assessed based on ACC/AHA guidelines. Univariate analysis of demographic and clinical variables was expressed as percentages and mean +/- standard deviation. Chi Square or Fischer exact test was used to assess association between independent and outcome variables. RESULTS: Males accounted for 58.5% of the cohort. Length of stay averaged 3.6+/-2 days. Classification by the ACC criteria showed 58.3%, 23.3% and 18.3% for class1, II, and III respectively. There was significant agreement between the ACC classification and the institutional telemetry admission criteria, 95% fit (p<0.001). Of the 120 patients studied, 83% met the institutional criteria. The emergency room was the commonest source of admission (84.1%). Shortness of breath was a common presenting symptom (47.5%). The rate of telemetry event was 32.5%. Of the 37 telemetry events, 18.9% were major while 81.1% were minor. The severity of telemetry event was associated with the request for consult service by primary physician (p = 0.03). CONCLUSION: The high concordance between institutional policy and the ACC criteria as well as the high compliance found is necessary to ensure efficiency of telemetry resource utilization. This could lead to reduction in cost of hospitalization and patients wait time.