Purpose: We evaluated management decisions of house staff in a university hospital emergency department (ED) to determine the impact of baseline electrocardiogram (ECG) results on the care of elderly patients.
Subjects and methods: The study employed a prospective before-after research design. The subjects included internal medicine house staff assigned to the ED and the 47 elderly patients treated by them during 58 ED visits. The measures of impact on patient care included how often and in what ways comparison of baseline and ED ECG results changed the house staff's diagnostic impressions and treatment plans. To determine changes, we asked house staff to indicate their impressions and management plans before and after comparing baseline and ED ECG results. In addition, a panel of faculty members used a modification of the nominal group process to determine treatment changes and to estimate benefit to patients from the changes.
Results: House staff indicated that baseline ECG results led them to change diagnostic impressions during 13 (22%) and treatment plans during eight (14%) of the 58 visits. Six of the patients benefited from the treatment changes. The faculty judges indicated that baseline ECG findings would have altered their diagnostic impressions in eight (14%) and treatment decisions in three (5%) of the 58 cases, one of which would have benefited from the change. All patients for whom there were changes of impression or plan had prior histories of cardiovascular disease.
Conclusion: We conclude that baseline ECGs provide ED house staff with diagnostic information that often leads to changes in management of elderly patients with prior histories of cardiovascular disease. Future studies should evaluate the efficacy of baseline ECGs in patients without such histories.