Improving Door-to-ECG Time at a Quaternary Care Emergency Department.

Area of Science:

• Emergency Medicine
• Quality Improvement Science
• Cardiology

Background:

• Timely electrocardiogram (ECG) completion is critical for diagnosing ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED).
• The American Heart Association recommends ECG acquisition within 10 minutes for patients with acute coronary syndrome symptoms.
• The study aimed to improve the percentage of patients with door-to-ECG (DTE) times under 10 minutes from 53.7% to over 75%.

Purpose of the Study:

• To implement and evaluate a quality improvement project to reduce door-to-ECG times in an academic ED.
• To increase the proportion of patients receiving ECGs within 10 minutes of arrival.
• To analyze the impact of specific interventions on DTE metrics.

Main Methods:

• A quality improvement project was conducted in an academic, quaternary care ED starting June 2022.
• Adult patients presenting with chest pain and a troponin order were included.
• Key interventions included nurse role modification, staff education, and increased monitoring, with analysis using statistical process control charts.

Main Results:

• The percentage of patients with DTE times under 10 minutes increased from 53.7% to 80.0%, exceeding the target.
• Interventions included reallocating a nurse, providing staff education, and increasing waiting room staff.
• During a one-year maintenance phase without new interventions, the DTE metric decreased to 71.3%.

Conclusions:

• Rapid Plan-Do-Study-Act (PDSA) cycles successfully improved DTE times to over 80%.
• Nursing role adjustments, education, recognition, and staffing increases were key drivers of improvement.
• These strategies are transferable to other departments and may show sustained benefits without constant oversight.