Background: Early STEMI identification using electrocardiogram (ECG) in Emergency Department (ED) patients is critical to timely intervention. The AHA recommends all ED chest pain ECGs be obtained within 10 minutes of arrival and immediately screened for STEMI. Approximately 40% of ECGs done in triage are interpreted as “Normal ECG” (NECG) or “Otherwise Normal ECG” (ONECG) by internal computer software and may not need immediate screening, however the reliability of these readings is uncertain and no studies have investigated the time spent obtaining a confirmatory read. This study aims to determine the time it takes for Patient Care Technicians (PCTs) to have ED attendings screen ECGs for adult triage patients.
Methods: This prospective cohort study was performed at a single academic ED with a volume of 122,000 visits/year. All adult ED patients who had a triage ECG performed according to standard protocol were included. ECGs were obtained within 10 minutes of arrival and immediately taken to an ED attending for review. All ECGs were time-stamped when the PCT departed triage and again upon PCT return. The data were entered into RedCap and descriptively analyzed.
Methods: We collected 1,768 ECGs during the 4-month study. Patient gender for all ECGs collected was M: 44% and F: 56%. The mean subjects’ age was 53.6 years. Distribution of automated readings was: “NECG” 33.7%, “ONECG” 11.2%, with borderline and abnormal making up the remaining 55.1%. Seven percent of the ECGs were missing or had an unreadable departure or return timestamp. The median time PCTs spent getting an ECG screened was 2.8 minutes (IQR 2,4). Total time spent getting an ECG read by a physician during the study period was 76.7 hours. Attending physicians were interrupted on average 14.6 times per day to screen these ECGs.
Conclusion: This study demonstrates that screening ECGs from triage is a time-consuming process that, perhaps unnecessarily, increases the number of physician interruptions. Although our findings are not generalizable, issues pertaining to workflow, interruptions of providers, patient care, and patient safety are universal. Next steps include comparing the “NECG” and “ONECG” readings with a cardiologist’s impressions to determine if physician screening can be deferred until the clinical encounter.