Quality assurance in the emergency department: evaluation of the ECG review process

To determine whether the review of emergency department ECGs by cardiologists contributes to the quality of patient care.

We retrospectively analyzed ED ECGs and compared interpretations of the treating emergency physicians with those of the reviewing cardiologists. We then evaluated the ED care of patients with potentially significant ECG abnormalities that were not detected by the treating emergency physicians, as well as the care of patients whose ECGs were "flagged" by the reviewing cardiologists as needing follow-up.

University hospital.

Four hundred consecutive ECGs obtained on ED patients.

Thirty-three of the 400 tracings had undetected potentially significant or critical ECG abnormalities; this adversely affected patient care in two cases. These two tracings were not flagged by the reviewing cardiologists. Thirteen ECGs were flagged by the cardiologists; patient care was not altered in any of these cases.

Review of ED ECGs by cardiologists did not affect patient care at our institution.