A prospective analysis of time to screen protocol ECGs in adult Emergency Department triage patients

Am J Emerg Med. 2021 Aug;46:23-26. doi: 10.1016/j.ajem.2020.03.025. Epub 2020 Mar 19.

Abstract

Background: Early identification of ST elevation MI (STEMI) in emergency departments (ED) via electrocardiogram (ECG) expedites intervention. While screening of all ED chest pain ECGs should be obtained within 10 minutes per the American Heart Association, 40% of all ECGs are software-analyzed as "Normal" or "Otherwise Normal." However, the reliability of this analysis and the time for confirmation read are uncertain. This study investigates the time necessary for Patient Care Technicians (PCTs) to deliver ECGs to ED attendings to confirm automated interpretation.

Methods: A prospective cohort study was conducted at a single academic ED. All patients ≥18 years who had a triage ECG were included. ECGs were obtained within 10 min of arrival, time-stamped, delivered for ED attending review and time-stamped upon PCT return to triage. Data were entered into REDCap and analyzed using StatPlus.

Results: During the 4-month study, 1768 ECGs were collected. Distribution of automated readings was: "Normal ECG" 33.7%; "Otherwise Normal ECG" 11.2%; and "borderline/abnormal" 55.1%. The median time necessary for PCTs to confirm a screening ECG was 2.8 min (IQR 2,4) with attending physicians interrupted an average of 14.6 times per day.

Conclusion: Screening of triage ECGs is time-intensive and compounds the frequency of physician interruptions. Although findings are not generalizable, the impact of these interruptions on patient care and safety is paramount and universal. Future directions include validating the reliability of "Normal" and "Otherwise Normal" ECG automated readings to obviate the need to interrupt ED physician for expedited screening confirmation.

Keywords: ECG; Physician interruptions; STEMI; Triage; Triage-ECGs; Workflow.

MeSH terms

  • Chest Pain / diagnosis*
  • Chest Pain / etiology
  • Clinical Protocols
  • Electrocardiography / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • ST Elevation Myocardial Infarction / diagnosis*
  • Time Factors
  • Triage / methods
  • Triage / statistics & numerical data*