Reducing door-to-ECG time in the emergency department: a quality improvement report

Patients presenting emergently with chest pain often experience delays in obtaining an ECG. Studies have found variability in care for patients with acute coronary syndrome, with many patients facing delays to receiving timely ECGs. Delays in acquisition are associated with increased morbidity and mortality.

Prior to our intervention, median time to ECG in the emergency department (ED) was 16.7 min, with peak times reaching 20.7 min in January 2024, exceeding American College of Cardiology/American Heart Association guidelines recommending an ECG within 10 min of arrival. Contributing factors included workflow inefficiencies, inadequate staffing and process inconsistency.

A quality improvement initiative was implemented from February 2024 to February 2025 aimed at reducing time to ECG and time to ECG interpretation. Key interventions included nursing education, process standardisation, stamps to standardise documentation, ECG responsibility reallocation (triage ECGs done by nurses, floor ECGs done by techs) and the creation of a designated ECG space in triage.

There were 3510 eligible ECGs conducted across the 12-month intervention period with 1522 ECGs (43.4%) meeting the <10 min goal. The initiative led to a reduction in time to ECG by 4.68 min (95% CI -7.74 to -1.62), a 10.8% reduction in median door-to-ECG time from 1 year prior to the intervention (12.9 min to 11.4 min), and a 32% reduction in median door-to-ECG time (16.7 min to 11.4 min) from 6 months prior to the intervention. There was a 74% reduction in median ECG interpretation time (101 min to 26.5 min) over 12 months.

Process standardisation, role delegation and education effectively reduced ECG times in the ED. Changes in staff who complete ECGs and standardisation of documentation may aid in improving performance metrics in ED settings.