Evaluation of a new emergency department triage process on door-to-ECG time
department or school: Applied Science, Faculty of
department or school: Nursing, School of
data provider: DSpace
degree campus: UBCV
creator: Khoshnood Rashti, Neda
issued: 2019-10-11T16:06:01Z
issued: 2019
related degree: Master of Science in Nursing - MSN
degree grantor: University of British Columbia
description: Background: Acute coronary syndrome (ACS) including acute myocardial infarction (AMI) is one of the leading causes of morbidity and mortality in Canada, and commonly seen in the emergency department (ED). A 12-lead electrocardiogram (ECG) is the most important initial step in diagnosis and treatment of ACS patients. Best-practice guidelines recommend ECG acquisition within 10 minutes of ED arrival for all suspected ACS patients. However, many hospitals have been unsuccessful in achieving this quality benchmark. A new triage process, included a multi-pronged, interdisciplinary approach to obtaining an ECG prior to patients being registered, including educating staff, creating a 7-step process guide, and designating an ECG space. Purpose: To evaluate the effect of pre-registration ECGs for walk-in patients with suspected ACS, on door-to-ECG (D2ECG) time. Method: We used a retrospective, quasi-experimental design with a historical comparison group. Patients with suspected ACS not arriving via ambulance were included. Suspected cardiac arrhythmia patients were also included to analyze for possible untoward effects of the intervention. Data from two 9-month periods yielded a sample of 4115 (pre-implementation [group 1], n=2042; post-implementation [Group 2], n=2073), with the same proportion of suspected ACS patients in each group. Data on sex, age, time of arrival, chief complaint code and ECG time was retrieved from the hospital electronic database and analyzed. Mann-Whitney U test, Kruskal-Wallis test and hierarchical multiple linear regression were used for analysis. Results: Median D2ECG time was shorter for suspected ACS patients in group 2, Mdn=10 minutes (IQR, 7-21), than group 1 Mdn= 40 minutes (IQR, 28-59), p=0.00. D2ECG time among suspected cardiac arrhythmia patients was also shorter post-implementation, p=0.00. Multiple linear regression demonstrated that the new triage process was associated with an 81% reduction in D2ECG time. Older patients and women had …
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/71883
note: EVALUATION OF A NEW EMERGENCY DEPARTMENT TRIAGE PROCESS ON DOOR-TO-ECG TIME by Neda Khoshnood Rashti B.S.N, University of British Columbia, 2012 B.Sc., Simon Fraser University, 2009 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES THE UNIVERSITY OF BRITISH COLUMBIA Vancouver October 2019 © Neda Khoshnood Rashti, 2019 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, a thesis entitled: Evaluation of a new emergency department triage process on door-to-ECG time submitted by Neda Khoshnood in partial fulfillment of the requirements for the degree of Master of Science in Nursing Examining Committee: Dr. Martha Mackay Supervisor Dr. Susan Dahinten Supervisory Committee Member Dr. Corrine Hohl Supervisory Committee Member iii Abstract Background: Acute coronary syndrome (ACS) including acute myocardial infarction (AMI) is one of the leading causes of morbidity and mortality in Canada, and commonly seen in the emergency department (ED). A 12-lead electrocardiogram (ECG) is the most important initial step in diagnosis and treatment of ACS patients. Best-practice guidelines recommend ECG acquisition within 10 minutes of ED arrival for all suspected ACS patients. However, many hospitals have been unsuccessful in achieving this quality benchmark. A new triage process, included a multi-pronged, interdisciplinary approach to obtaining an ECG prior to patients being registered, including educating staff, creating a 7-step process guide, and designating an ECG space. Purpose: To evaluate the effect of pre-registration ECGs for walk-in patients with suspected ACS, on door-to-ECG (D2ECG) time. Method: We used a retrospective, quasi-experimental design with a historical comparison group. Patients with suspected ACS not arriving via ambulance were included. Suspected cardiac arrhythmia …
has type: Thesis/Dissertation
date issued: 2019-11
is shown at: 10.14288/1.0383356
language: eng
degree discipline: Nursing
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
type: Text
identifier URI: http://hdl.handle.net/2429/71883