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

Objective: To improve compliance with a target door-to-electrocardiogram (EKG) time of 10 minutes or less in patients presenting with symptoms concerning for acute coronary syndrome. Methods: A pre-post study was performed between January 2014 and May 2016 at five emergency departments (EDs) in Saudi Arabia. Patients who presented to ED with symptoms concerning for acute coronary syndrome were included in the study. The primary outcome of interest was whether EKG was completed within 10 minutes after the patient arrival to ED. Quality improvement interventions consisted of human resources adjustments, education, technological improvements, and improved interdepartmental collaboration. Multivariate analysis was used to model the percentage of EKGs that were completed within the targeted time. Results: During the study period, 11,518 patients received EKGs. Prior to the intervention, compliance with a door-to-EKG time of 10 minutes or less was found to be 62.6%. Post intervention, compliance improved to 87.7%. On multivariate analysis, male patients were significantly more likely to receive EKG within 10 minutes than female patients (odds ratio = 1.231, 95% confidence interval = 1.113–1.361; p < 0.001). Conclusion: A quality improvement project can successfully increase the percentage of patients receiving EKG within 10 minutes of presentation to ED. Further research is required to demonstrate the clinical significance of improved door-to-EKG times.