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A quality improvement project to reduce door-to-electrocardiogram time: A multicenter study.

Anne Keats1,2, Dane Moran3, Siobhan Rothwell1

  • 1Department of Emergency Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

Journal of the Saudi Heart Association
|July 10, 2018
PubMed
Summary

Quality improvement initiatives successfully reduced door-to-electrocardiogram (EKG) times for acute coronary syndrome patients. Compliance with the 10-minute target increased significantly, improving patient care efficiency.

Keywords:
ElectrocardiographyEmergency serviceHospitalQuality improvement

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Area of Science:

  • Emergency Medicine
  • Quality Improvement Science
  • Cardiology

Background:

  • Timely electrocardiograms (EKGs) are crucial for diagnosing acute coronary syndrome (ACS).
  • Achieving a target door-to-EKG time of 10 minutes or less is a key performance indicator in emergency departments (EDs).
  • Previous compliance rates for this target were suboptimal, necessitating quality improvement efforts.

Purpose of the Study:

  • To enhance compliance with a 10-minute door-to-EKG time for patients presenting with ACS symptoms.
  • To evaluate the effectiveness of targeted quality improvement interventions in a real-world clinical setting.

Main Methods:

  • A pre-post study design was implemented across five EDs in Saudi Arabia from January 2014 to May 2016.
  • Quality improvement interventions included optimizing staffing, providing education, upgrading technology, and fostering interdepartmental collaboration.
  • Multivariate analysis was employed to assess factors influencing door-to-EKG times.

Main Results:

  • A total of 11,518 patients underwent EKG during the study period.
  • Pre-intervention compliance with the 10-minute door-to-EKG goal was 62.6%.
  • Post-intervention compliance significantly improved to 87.7%. Male patients showed a higher likelihood of receiving timely EKGs.

Conclusions:

  • Quality improvement projects are effective in increasing the percentage of patients receiving EKGs within 10 minutes of ED arrival.
  • The study highlights the success of multifaceted interventions in improving critical care pathways.
  • Further research is needed to establish the clinical significance and patient outcomes associated with reduced door-to-EKG times.