Document Detail


Improving emergency department door-to-electrocardiogram time in ST segment elevation myocardial infarction.
MedLine Citation:
PMID:  19726931     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
For patients presenting to emergency departments (ED) with a suspected acute coronary syndrome, time of arrival until an electrocardiogram is performed is an important quality metric. In our ED routine quality monitoring found that mean door-to-electrocardiogram (D2ECG) time did not meet our goal and national benchmark of 10 minutes. We describe the use of quality improvement tools to assess and decrease our D2ECG time. The ED quality improvement committee identified 2 main causes of D2ECG >10 minutes: (1) priority delay (eg, completing triage and registration data entry tasks before ECG), and (2) failure to recognize patients with nonchest pain ST Elevation Myocardial Infarction (STEMI) symptoms. Interventions included are-designed patient prioritization process for triage, staff assignment to provide immediate ECG testing, continuous feedback and a triage staff educational initiative to identify high risk patients. Mean time to ECG before intervention was 21.28 +/- 5.49 minutes. After the intervention period, the mean D2ECG for STEMI decreased to 9.47 +/- 2.48 minutes representing a 55% improvement. A D2ECG time of less than 10 minutes time can be achieved by the implementation of patient prioritization triage process changes, assigning specific personnel to obtain the ECG, continuous feedback by reviewing cases that fall outside the 10-minute goal and by ED staff education regarding STEMI symptoms other than chest pain.
Authors:
Michael P Phelan; Jon Glauser; Elizabeth Smith; Craig Martin; Stefanie Schrump; Pat Mahone; W Frank Peacock
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  8     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-03     Completed Date:  2009-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  119-21     Citation Subset:  IM    
Affiliation:
Cleveland Clinic, Department of Emergency Medicine, Cleveland, OH 44195, USA. PhelanM@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / methods
Cohort Studies
Critical Pathways / organization & administration*
Electrocardiography*
Emergency Service, Hospital / standards*,  trends
Emergency Treatment / standards,  trends
Female
Follow-Up Studies
Health Care Surveys
Hospital Mortality / trends
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*,  mortality,  therapy
Quality of Health Care
Risk Assessment
Survival Analysis
Time Factors
Treatment Outcome
Triage / standards

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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