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Pre-operative electrocardiograph examination
G F Nash1, G H Cunnick, S Allen
1guy.nash@ic.ac.uk
Insights
Pre-operative electrocardiograms (ECGs) are often not fully reviewed by doctors before surgery. This pilot study found that 30% of ECGs were not opened, indicating potential underutilization of cardiac assessments.
Area of Science:
- Cardiology
- Surgical Care
- Medical Diagnostics
Background:
- Cardiac events are the leading cause of post-surgical mortality.
- Electrocardiograms (ECGs) are standard pre-operative tests for coronary artery disease.
- Assessing the utilization of pre-operative ECGs is crucial for patient safety and resource management.
Purpose of the Study:
- To investigate the examination rate of pre-operative electrocardiographs by physicians.
- To determine if pre-operative ECGs are consistently reviewed and documented.
Main Methods:
- A pilot study involved 50 adult patients undergoing general surgery requiring an ECG.
- ECG tracings were intentionally obscured (folded, paperclip) to assess if doctors removed obstructions for viewing.
- Patient records were reviewed for documentation of ECG performance.
Main Results:
- 30% of electrocardiograms (ECGs) were not opened by medical staff.
- 58% of patient records lacked any mention of the ECG being performed.
- No correlation was found between ECG examination rates and patient age or fitness.
Conclusions:
- The study suggests a potential sub-optimal use of pre-operative ECG resources in clinical practice.
- Further audits are warranted to confirm these findings and improve ECG utilization.
- Ensuring proper review of pre-operative ECGs is essential for optimizing surgical patient care.
Abstract:
The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit.