Abstract
Background: National guidelines recommend electrocardiograms (EKGs) within 10 minutes of arrival to the emergency department (ED) to evaluate myocardial infarctions (MIs) (Gulati et al., 2021; O’Gara et al., 2013). Approximately 20% of MI patients do not present with chest pain (Cannon et al., 2014). In reviewing this, an academic medical center noted fewer than 60% of MI patients met benchmark, with a median of 8 minutes. STEMI EKG adherence was 50-100%, while NSTEMI adherence was 53–76%.
Purpose: In treating ED patients with MIs, does integrating an evidence-informed clinical decision screening tool (CDS) improve the percentage of patients meeting door-to-EKG times within 10 minutes?
Methods: A CDS tool was developed using a study by Glickman et al. (2012) that reviewed patients with MIs and validated associated age and chief complaint. Screening criteria included:
• ≥30 years with chest pain
• ≥50 years with dyspnea, altered mental status, upper extremity pain, syncope, weakness, or chest pain
• ≥80 years with nausea, vomiting, abdominal pain, dyspnea, altered mental status, upper extremity pain, syncope, weakness, or chest pain
Using four PDSA cycles, staff were educated, nurse-initiated EKG orders were incorporated into protocols, and automated alerts prompted EKG orders upon meeting criteria.
Findings: Over four months, 3,687 patients were evaluated, with 92% of STEMI patients (n = 25) meeting benchmark with an average of 5.04 minutes; 82% of NSTEMI patients (n = 39) met benchmark with a 9.13-minute average.
Conclusions: Findings support use of a CDS tool in triaging ED patients for MIs to reduce door-to-EKG times.
