SAN FRANCISCO — Dedicating an ECG technician to the emergency department triage team shortened the wait for ECGs in patients with ST-elevation MI, but it didn't decrease times to reperfusion, Kathy Parish, R.N., reported.
She and her associates in the emergency department at William Beaumont Hospital, Royal Oak, Mich., compared arrival-to-ECG times and arrival-to-reperfusion times in the first 6 months of 2005 with data from the second 6 months of 2005 after institution of a rapid-ECG protocol.
In the first half of the year, education, training, and posters in the emergency department emphasized guidelines for rapid ECG of potential STEMI patients, but the triage team did not include a dedicated ECG technician. In the second half of the year, patients assessed by the triage nurse as having potential STEMI bypassed routine processing and underwent ECG by a technician assigned to the triage team for that purpose, she said in a poster presentation at the annual meeting of the Society for Academic Emergency Medicine.
Patients qualified for rapid ECG during either period if they were at least 30 years old with chest pain or at least 50 years old with syncope, weakness, rapid heartbeat or palpitations, difficulty breathing, or shortness of breath.
Data for 144 patients ultimately diagnosed with STEMI showed that the rapid-ECG protocol significantly decreased arrival-to-ECG times from 26 minutes in the control period to 10 minutes. The proportion of patients who waited longer than 30 minutes for an ECG also significantly decreased, from 19% to 2%.
The proportion of patients who underwent an ECG within 10 minutes did not change significantly: 64% in the control period and 50% with the rapid-ECG protocol. A slight increase in arrival-to-reperfusion times—from 100 minutes in the control period to 105 minutes in the trial period—was not significant.