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Routine admission electrocardiography in emergency department patients
1Department of Medicine, University of Pittsburgh, PA.
Insights
Routine electrocardiograms (ECGs) in emergency department (ED) admissions could be safely avoided in some patients. This could lead to significant cost savings in healthcare without negatively impacting patient outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Health Economics
Background:
- The routine performance of electrocardiograms (ECGs) upon admission from the emergency department (ED) is a common practice.
- The necessity and cost-effectiveness of routine ECGs in all admitted patients are debated.
Observation:
- A retrospective study reviewed 636 ED admissions to a university hospital's medical service.
- Of 247 patients without clear indications for an ECG, 202 received one routinely.
- Routine ECGs in this subset led to management changes in only 1.5% and no adverse outcomes.
Findings:
- A significant portion of admission ECGs may be considered routine, performed without documented indications.
- In patients without indications, routine ECGs rarely altered management or affected outcomes.
- Patients who did not receive a routine ECG when indicated had no identifiable adverse consequences.
Implications:
- Avoiding routine ECGs in selected ED admissions could yield substantial cost savings for the healthcare system.
- These findings suggest a need to re-evaluate current guidelines for ECG use in emergency medicine.
- Further research in diverse patient populations is warranted to confirm these cost-saving opportunities.
Study Objectives:
To determine whether routine performance of an ECG could have been safely avoided in a subset of emergency department patients admitted to a university hospital.
Design:
Retrospective consecutive case series.
Setting:
University teaching hospital.
Type Of Participants:
All ED patients admitted to the medical service of the study hospital during a three-month period.
Methods And Interventions:
Acceptable indications for an admission ECG were prospectively developed. Charts of all patients were reviewed to determine whether any of these indications were present, whether an admission ECG was performed, and whether an admission ECG resulted in a change in patient management or outcome. An ECG was classified as routine when performed in the absence of documentation of any of these indications. No interventions were performed.
Measurements And Main Results:
There were 636 ED admissions to the medical service during the study period. Of the 631 patients whose chart could be located, 384 (61%) had at least one indication for an ECG and all but one had an ECG performed. No indications for an admission ECG were identified in the remaining 247 patients; of these, 202 (82%) had an ECG performed and 45 (18%) did not. Among the 202 who had a routine admission ECG, the test resulted in a change in management in only three (1.5%) (95% confidence interval [CI], 0.3% to 4.3%) and affected patient outcome in none (95% CI, 0% to 1.5%). Among the 45 without indications who did not have a routine admission ECG, none experienced an identifiable adverse consequence during hospitalization (95% CI, 0% to 6.7%).
Conclusion:
The admission ECG could have been avoided in an identifiable subset of ED patients admitted to the medical service of our hospital, with no adverse effect on patient outcome. This finding, if corroborated in other patient populations, suggests the potential for significant cost savings for the US health care system as a whole.