Panoramic ECG display versus conventional ECG: ischaemia detection by critical care nurses
Nick Wilson1, Aimen Hassani, Vanessa Gibson
1Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford Campus, Chelmsford, UK.
Insights
The Panoramic ECG display tool significantly improved critical care nurses' accuracy and certainty in diagnosing cardiac ischaemia compared to conventional 12-lead ECG alone. This enhances early detection of myocardial ischaemia in critically ill patients.
Area of Science:
- Critical care medicine
- Cardiology
- Nursing education
Background:
- Critically ill patients are at high risk for myocardial ischaemia, with ECG changes often being the sole indicator.
- Critical care nurses play a vital role in prompt ECG interpretation, but expertise can be limited, leading to missed diagnoses.
- Subtle ECG changes indicative of ischaemia may go undetected by critical care staff.
Purpose of the Study:
- To evaluate the impact of the Panoramic ECG display tool on the diagnostic accuracy and certainty of critical care nurses in identifying cardiac ischaemia.
- To compare the effectiveness of the Panoramic ECG display tool combined with a 12-lead ECG against the 12-lead ECG alone.
Main Methods:
- An online survey was administered to members of the British Association of Critical Care Nurses (BACCN).
- Participants analyzed two sets of eight ECGs, first with a conventional 12-lead ECG and then with the 12-lead ECG supplemented by the Panoramic ECG display tool.
- Diagnostic accuracy and certainty scores were recorded for both methods.
Main Results:
- Diagnostic accuracy increased from 67.1% with the 12-lead ECG alone to 96.0% with the addition of the Panoramic ECG display tool (P < 0.01).
- Diagnostic certainty scores rose significantly from 41.7% to 66.8% (P < 0.01) when using the Panoramic ECG display tool.
- The tool demonstrated the greatest benefit for nurses with lower confidence in interpreting conventional ECGs and in detecting early ischaemic changes.
Conclusions:
- The Panoramic ECG display tool significantly enhances critical care nurses' ability to accurately and confidently detect ST segment changes indicative of cardiac ischaemia.
- Integration of this tool into clinical practice has the potential to expedite treatment for myocardial ischaemia, thereby reducing patient morbidity and mortality.
- The tool offers substantial support to nurses, particularly those less experienced in ECG interpretation, improving patient care outcomes.
Aim:
To compare accuracy and certainty of diagnosis of cardiac ischaemia using the Panoramic ECG display tool plus conventional 12-lead electrocardiogram (ECG) versus 12-lead ECG alone by UK critical care nurses who were members of the British Association of Critical Care Nurses (BACCN).
Background:
Critically ill patients are prone to myocardial ischaemia. Symptoms may be masked by sedation or analgesia, and ECG changes may be the only sign. Critical care nurses have an essential role in detecting ECG changes promptly. Despite this, critical care nurses may lack expertise in interpreting ECGs and myocardial ischaemia often goes undetected by critical care staff.
Method:
British Association of Critical Care Nurses (BACCN) members were invited to complete an online survey to evaluate the analysis of two sets of eight ECGs displayed alone and with the new display device.
Results:
Data from 82 participants showed diagnostic accuracy improved from 67·1% reading ECG traces alone, to 96·0% reading ECG plus Panoramic ECG display tool (P < 0·01, significance level α = 0·05). Participants' diagnostic certainty score rose from 41·7% reading ECG alone to 66·8% reading ECG plus Panoramic ECG display tool (P < 0·01, α = 0·05).
Conclusion:
The Panoramic ECG display tool improves both accuracy and certainty of detecting ST segment changes among critical care nurses, when compared to conventional 12-lead ECG alone. This benefit was greatest with early ischaemic changes. Critical care nurses who are least confident in reading conventional ECGs benefit the most from the new display.
Relevance To Clinical Practice:
Critical care nurses have an essential role in the monitoring of critically ill patients. However, nurses do not always have the expertise to detect subtle ischaemic ECG changes promptly. Introduction of the Panoramic ECG display tool into clinical practice could lead to patients receiving treatment for myocardial ischaemia sooner with the potential for reduction in morbidity and mortality.
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