Carolinas Medical Center

Background: Electrocardiography (ECG) is the most important data element used to stratify patients (pts) requiring emergency cardiac care. It has been proposed that the ECG should be available to the physician within 10 minutes of pt arrival to the emergency department (ED). SCPC accreditation criteria for Key Element 2 (attack) and Key Element 7 (mapping) address this. We mapped and analyzed the component steps inherent to the interpretation of initial 12-lead ECGs in the ED. Methods: We conducted an observational study of initial ECGs obtained in an urban teaching hospital ED (census 106,000). Study sample included consecutive pts receiving an ECG in the high-acuity area of the ED when a dedicated observer was present (3–6 days/ wk, 5–10 hours/day primarily between 8 am and 8 pm). Data for prehospital (PH) ECGs were evaluated for patients presenting by ambulance. Results: One hundred fifty-eight patients were enrolled; 144 had complete data. Of 71 ambulance-transported pts, 42 (59%) had ECGs obtained by paramedics. ECGs were obtained by RNs before MD evaluation in 104 (72%) pts. Intervals (min) from 1) hospital arrival to room placement, 2) room placement to ECG order, 3) ECG order to acquisition, 4) acquisition to interpretation, and 5) total (hospital arrival to MD interpretation) were as shown in the table. Only 8 patients (5.6%) had ECG interpretation by MD within 10 minutes of hospital arrival. Conclusions: Inconsistencies influencing timeliness of ECG acquisition and interpretation are identified. Individual steps in the process are often accomplished in a timely manner, but delays in the course accumulate. Factors associated with rapid MD review of ECG include ambulance transport, direct triage to monitored bed, and nurse initiative in acquisition. These data will be used in the refinement of the process of ECG interpretation in the ED.TABLE 1: Results