Quality Improvement in the Emergency Department: A Project to Reduce Door-to-Electrocardiography Times for Patients Presenting With Chest Pain

Barbara Maliszewski, Madeleine Whalen, Cathleen Lindauer, Kelly Williams, Heather Gardner, Diana Lyn Baptiste

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The American Heart Association/American College of Cardiology guidelines recommend obtaining electrocardiography for patients who present to the emergency department with chest pain in less than 10 minutes of arrival. Reducing door-to-electrocardiography time is an important step in adhering to the recommended door-to-balloon times (≤ 90 minutes) for patients who present with ST-segment elevation myocardial infarction. Methods: Based on lean sigma principles, a protocol was implemented in an adult emergency department that included deferring nurse triage for patients with complaints of chest pain, chest tightness, and chest pressure and providing them with a red heart symbol as an indicator for clinical technicians to prioritize their electrocardiography order. Pre- and postintervention data were collected over a 12-month period. Results: Before the intervention, the mean door-to-electrocardiography time was 17 minutes for patients with chest pain (n = 893). After the intervention, the mean door-to-electrocardiography time for patients with chest pain significantly decreased to 7 minutes (n = 1,057) (t = 10.47, P ≤ 0.001). Initially, the percentage of compliance with door-to-electrocardiography standard of 10 minutes was 31% and improved to 83% after implementation of the new protocol. Discussion: Implementation of the optimized door-to-electrocardiography protocol decreased the time for obtaining diagnostics and improved compliance with the American Heart Association/American College of Cardiology guidelines, potentially decreasing door-to-balloon times for patients who presented with ST-segment elevation myocardial infarction.

Original languageEnglish (US)
Pages (from-to)497-504.e2
JournalJournal of Emergency Nursing
Volume46
Issue number4
DOIs
StatePublished - Jul 2020

Keywords

  • Chest pain
  • Electrocardiography
  • Emergency medicine
  • Emergency nursing
  • Myocardial infarction

ASJC Scopus subject areas

  • Emergency

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