Key result
Standardized triage workflow linked to ~5-minute reduction in emergency door-to-ECG time.
Why the study?
Patients presenting emergently with chest pain often experience delays in obtaining timely ECGs, which are associated with increased morbidity and mortality.
Does a quality improvement initiative focusing on process standardization and role delegation reduce door-to-ECG time in low-risk adult patients presenting to the emergency department with chest pain?
Observational (n=3,510)
No
Does a quality improvement initiative focusing on process standardization and role delegation reduce door-to-ECG time in low-risk adult patients presenting to the emergency department with chest pain?
Mean Difference: -4.68 (95% CI -7.74–-1.62)
Absolute Event Rate: 11.4% vs 16.7%
p-value: p=<0.05
A multidisciplinary quality improvement initiative involving role delegation and workflow standardization effectively reduced door-to-ECG times and improved adherence to guidelines for low-risk chest pain evaluations.
Supports local ED workflow standardization; leaves open effects on clinical outcomes and need for controlled validation.
BACKGROUND: Patients presenting emergently with chest pain often experience delays in obtaining an ECG. Studies have found variability in care for patients with acute coronary syndrome, with many patients facing delays to receiving timely ECGs. Delays in acquisition are associated with increased morbidity and mortality. LOCAL PROBLEM: Prior to our intervention, median time to ECG in the emergency department (ED) was 16.7 min, with peak times reaching 20.7 min in January 2024, exceeding American College of Cardiology/American Heart Association guidelines recommending an ECG within 10 min of arrival. Contributing factors included workflow inefficiencies, inadequate staffing and process inconsistency. METHODS: A quality improvement initiative was implemented from February 2024 to February 2025 aimed at reducing time to ECG and time to ECG interpretation. Key interventions included nursing education, process standardisation, stamps to standardise documentation, ECG responsibility reallocation (triage ECGs done by nurses, floor ECGs done by techs) and the creation of a designated ECG space in triage. RESULTS: There were 3510 eligible ECGs conducted across the 12-month intervention period with 1522 ECGs (43.4%) meeting the <10 min goal. The initiative led to a reduction in time to ECG by 4.68 min (95% CI -7.74 to -1.62), a 10.8% reduction in median door-to-ECG time from 1 year prior to the intervention (12.9 min to 11.4 min), and a 32% reduction in median door-to-ECG time (16.7 min to 11.4 min) from 6 months prior to the intervention. There was a 74% reduction in median ECG interpretation time (101 min to 26.5 min) over 12 months. CONCLUSIONS: Process standardisation, role delegation and education effectively reduced ECG times in the ED. Changes in staff who complete ECGs and standardisation of documentation may aid in improving performance metrics in ED settings.
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Srivatsa et al. (2025) conducted an observational in Chest pain with concern for acute coronary syndrome (low-risk) (n=3,510). Quality improvement initiative (nursing education, process standardization, ECG responsibility reallocation, and designated ECG space in triage) vs. Historical standard of care (pre-intervention period) was evaluated on Median door-to-ECG time (MD -4.68 min, 95% CI -7.74 to -1.62, p=<0.05). A quality improvement initiative utilizing process standardization and role delegation reduced median door-to-ECG time by 4.68 minutes in emergency department patients presenting with chest pain.
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