Improving Triage to ECG Time in the Emergency Department
Creators: name: Nosworthy, Sara Eileen
Publisher: name: Graduate Studies
Year: 2018
Subjects: subject: Triage to ECG Time
subject: Door to ECG Time
subject: Emergency Department
subject: Overcrowded
subject: STEMI
subject: Chest pain
subject: Nursing
subject: FOS: Health sciences

description: Background: The ST-segment elevation myocardial infarction (STEMI) team of a large Canadian urban tertiary care hospital identified that best practice recommendations were not being met for walk-in patients diagnosed with STEMI to the Emergency Department (ED). The American Heart Association (AHA) (2013) recommends triage to first-device time should be 90-minutes. However, this target was only achieved 6% of the time for walk-in patients diagnosed with STEMI. It is recommended that the initial electrocardiogram (ECG) be completed within 10-minutes for patients presenting with suspected ischemic chest pain (SICP) to the ED (AHA, 2013). Data analysis, performed by the STEMI quality improvement team, identified a significant delay with the initial ECG, for walk-in patients diagnosed with STEMI. This delay places patients at risk for serious adverse outcomes, such as cardiac arrest. Therefore, it was essential to implement a streamlined process to improve triage to ECG times. Objective: The objectives of this study were to investigate if the implementation of a streamlined process at triage for walk-in patients with SICP decreased triage to ECG times, and secondarily if triage to first-device time for walk-in patients diagnosed with STEMI was decreased. Methods: A retrospective study was conducted at a large Canadian urban tertiary care hospital. A new streamlined process at triage for walk-in patients presenting with SICP was evaluated by comparing daily data from May 2016 to May 2017. The primary outcome measured was triage to ECG time for walk-in patients presenting with SICP, and secondarily triage to first-device time for walk-in patients diagnosed with STEMI. Results: There was a statistically significant difference between May 2016 and May 2017 (U = 28425, Z=-5.01, p &lt;.001). Following the streamlined process there was a significant decrease of 16-minutes in the median triage to ECG time for walk-in patients presenting with SICP compared to those prior to the streamlined process. None of the 288 patients evaluated in May 2016 were diagnosed with STEMI. Four of the 265 patients evaluated in May 2017 were diagnosed with STEMIs. Two of the four patients met the recommended target time of triage to first-device time within 90-minutes (AHA, 2013: Heart and Stroke, 2015). Discussion: The best practice recommendation of triage to ECG time within 10-minutes was not achieved for all walk-in patients presenting with SICP. However, the streamlined process has significantly decreased time in triage to ECG for this patient population. Future interventions directed at decreasing triage to ECG time should focus on early identification of patients with chest pain, examining the streamlined process for further improvements, and ongoing evaluation of triage to ECG data. There was limited data for triage to first-device time as there were no walk-in patients diagnosed with STEMI in May 2016. Therefore, it was not possible to evaluate if the streamlined process improved triage to first-device time. Continual evaluation of the triage to first-device times is needed to see if the streamlined process is making a difference.