8 Quality improvement measures to reduce the time to ECG in patients self-presenting with chest pain
Year: 2023
Type: conference-paper
Study design: Clinical Trial
Abstract: Background The European Society of Cardiology recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for patients self-presenting to the emergency department (ED) with chest pain. We investigated whether modifying ED triage processes could improve door-to-ECG time after the implementation of Quality improvement (QI) strategies. Methodology This was a QI project with a pre-post study design using our hospital database during February to April 2022 (Pre-intervention) and March – April 2023 (Post-intervention). QI strategies implemented in our ED included: (1) setting up an ECG room in the triage area, (2) recruiting a dedicated ECG technician for ED, (3) fast-tracking patients with chest pain to the ECG technician and (4) training healthcare assistants to perform ECG. The primary outcome was the percentage of patients with chest pain who received ECG within 10 min of arrival; the secondary outcome was the percentage of patients with triage times of <15 min from arrival. Patients from the month pre- and post-QI initiative were defined as the control and intervention groups, respectively. Results Enrolment comprised 279 patients with chest pain: 143 pre-intervention and 136 post-intervention. Understaffing of triage nurses was the most common cause of delay in the door-to-ECG process, significantly impacting the triage time. QI measures resulted in a significant increase in the percentage of patients with door-to-ECG times <10 min (72.3% vs. 28.8%, p < 0.05), with a corresponding improvement in triage times <15 min (85.1% vs. 44.2%, p < 0.05). After adjustment for possible co-variates, the QI interventions remained a significant contributing factor for achieving the door-to-ECG and door-to-triage targets (figures 1 and 2). Conclusion The modification of ED triage processes through the implementation of QI strategies effectively achieves better door-to-ECG times and can allow for earlier identification and prompt treatment of STEMI. Protocol-driven multidisciplinary team approach with regular audits and QI measures can help improve door-to-ECG times.
Source: Heart
Authors: J Anderson, R Murphy, P Darcy, E O’Conor
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4387541540