TY - JOUR
T1 - Quality Improvement in the Emergency Department
T2 - A Project to Reduce Door-to-Electrocardiography Times for Patients Presenting With Chest Pain
AU - Maliszewski, Barbara
AU - Whalen, Madeleine
AU - Lindauer, Cathleen
AU - Williams, Kelly
AU - Gardner, Heather
AU - Baptiste, Diana Lyn
N1 - Publisher Copyright:
© 2020 Emergency Nurses Association
PY - 2020/7
Y1 - 2020/7
N2 - 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.
AB - 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.
KW - Chest pain
KW - Electrocardiography
KW - Emergency medicine
KW - Emergency nursing
KW - Myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85084210649&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084210649&partnerID=8YFLogxK
U2 - 10.1016/j.jen.2020.03.004
DO - 10.1016/j.jen.2020.03.004
M3 - Article
C2 - 32386775
AN - SCOPUS:85084210649
SN - 0099-1767
VL - 46
SP - 497-504.e2
JO - Journal of Emergency Nursing
JF - Journal of Emergency Nursing
IS - 4
ER -