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UBC Theses and Dissertations

Evaluation of a new emergency department triage process on door-to-ECG time Khoshnood Rashti, Neda


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 longer D2ECG times. Conclusion: Implementation of pre-registered ECGs is associated with an effective intervention in improving D2ECG time among suspected ACS patients in the ED.  

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