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Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review

  • Shawn Chhabra (a1), Debra Eagles (a1) (a2), Edmund S.H. Kwok (a1) and Jeffrey J Perry (a1) (a2)
Abstract
Objectives

We sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome.

Methods

Two reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline. Quality was assessed using the Quality Improvement Minimum Quality Criteria Set critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time.

Results

Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions, and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (2/11).

Conclusions

There are multiple interventions that show potential for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education, and better triage disposition. These changes can help institutions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

Objectif

L’étude visait à relever différentes interventions mises en œuvre au service des urgences (SU) afin de réduire le temps écoulé entre l'arrivée au SU et la réalisation de l'ECG chez les adultes présentant des symptômes évocateurs d'un syndrome coronarien aigu.

Méthode

Deux examinateurs ont effectué une recherche dans les bases de données Medline, Embase, CINAHL et Cochrane CENTRAL, depuis leur début respectif jusqu'en avril 2018, pour trouver des études menées chez des adultes traités au SU à la suite d'une intervention particulière visant à réduire le temps médian écoulé entre l'arrivée au SU et l'ECG par rapport aux valeurs habituelles, enregistrées dans les établissements concernés. La qualité des études a été appréciée à l'aide de l'instrument d’évaluation critique Quality Improvement Minimum Quality Criteria Set. Le principal critère d’évaluation consistait dans la réduction, en valeur absolue, du temps médian écoulé entre l'arrivée au SU et l'ECG, exprimée sous forme d’écart entre le temps avant l'intervention et le temps après l'intervention.

Résultats

Les deux examinateurs ont relevé 809 articles uniques et ont retenu 11 études d'amélioration de la qualité, de type avant/après, qui respectaient les critères de sélection (n = 15 622 patients). Dans la plupart des études (10/11), on avait mis en œuvre plusieurs interventions simultanément et, dans la plupart des analyses retenues (10/11), on a noté une amélioration statistiquement significative du temps écoulé entre l'arrivée au SU et l'ECG. Les interventions les plus courantes comprenaient : la présence d'un électrocardiographe et d'un technicien spécialisé en ECG au triage (5/11); une formation accrue du personnel affecté au triage (4/11); une amélioration des suites à donner au moment du triage (2/11); et des mécanismes de remontée des données (2/11).

Conclusion

Différentes interventions permettent donc de réduire le temps écoulé entre l'arrivée au SU et l'ECG. Celles qui se sont révélées efficaces comprenaient la présence d'un technicien spécialisé en ECG, une formation accrue du personnel affecté au triage et une amélioration des suites à donner au moment du triage. Toutes ces interventions peuvent aider les établissements à respecter les lignes directrices sur les pratiques exemplaires. Toutefois, avant même d'adopter une ou plusieurs interventions, les responsables des SU doivent examiner leur contexte local.

Copyright
Corresponding author
Correspondence to: Dr. Shawn Chhabra, The Ottawa Hospital Civic Campus, Department of Emergency Medicine, Room EM206, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; Email: schhabra@toh.ca
References
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1.Canadian Institute for Health Information. Sources of potentially avoidable emergency department visits our vision our mandate; 2014. Available at: https://secure.cihi.ca/free_products/ED_Report_ForWeb_EN_Final.pdf (accessed October 17, 2018).
2.Bhuiya, F, Pitt, S, McCaig, L. Emergency department visits for chest pain and abdominal pain: United States, are ED visits for chest or abdominal pain increasing? 2010. Available at: https://www-cdc-gov.proxy.bib.uottawa.ca/nchs/data/databriefs/db43.pdf (accessed October 17, 2018).
3.Anderson, JL, Adams, CD, Antman, EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. J Am Coll Cardiol 2007;50(7):e1157.
4.Diercks, DB, Kirk, JD, Lindsell, CJ, et al. Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med 2006;24:17.
5.Shavelle, DM, Chen, AY, Matthews, RV, et al. Predictors of reperfusion delay in patients with ST elevation myocardial infarction self-transported to the hospital (from the American Heart Association's Mission: Lifeline Program). Am J Cardiol 2014;113(5):798802.
6.Atzema, CL, Austin, PC, Tu, JV, Schull, MJ. Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients. CJEM 2011;13(2):7989.
7.Bradley, EH, Herrin, J, Wang, Y, et al. Door-to-drug and door-to-balloon times: Where can we improve? Time to reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI). Am Heart J 2006;151:12811287.
8.Hempel, S, Shekelle, PG, Liu, JL, et al. Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): a tool for critical appraisal of quality improvement intervention publications. BMJ Qual Saf 2015;24(12):796804.
9.Coyne, CJ, Bio, A. Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients. J Issue West J Emerg Med 2015;16(1):184189.
10.Kaila, KS, Bhagirath, KM, Kass, M, et al. Reperfusion times for ST elevation myocardial infarction: a prospective audit. McGill J Med 2007;10(2):7580.
11.Piggott, Z, Weldon, E, Strome, T, Chochinov, A. Application of lean principles to improve early cardiac care in the emergency department. CJEM 2011;13(5):325332.
12.Sprockel, JJ, Tovar Diaz, LP, Omaña Orduz, OP, et al. Optimization of door-to-electrocardiogram time within a critical pathway for the management of acute coronary syndromes at a teaching hospital in Colombia. Crit Pathw Cardiol 2015;14(1):2530.
13.Takakuwa, KM, Burek, GA, Estepa, AT, Shofer, FS. A method for improving arrival-to-electrocardiogram time in emergency department chest pain patients and the effect on door-to-balloon time for ST-segment elevation myocardial infarction. Acad Emerg Med 2009;16(10):921927.
14.Keats, A, Moran, D, Rothwell, S, et al. A quality improvement project to reduce door-to-electrocardiogram time: a multicenter study. J Saudi Hear Assoc 2018;30(3):180187.
15.Meils, CM, Kaleta, KA, Mueller, CL. Treatment of the patient with acute myocardial infarction: reducing time delays. J Nurs Care Qual 2002;17(1):8389.
16.Phelan, MP, Glauser, J, Smith, E, et al. Improving emergency department door-to-electrocardiogram time in ST segment elevation myocardial infarction. Crit Pathw Cardiol 2009;8(3):119121.
17.Higgins, GL, Lambrew, CT, Hunt, E, et al. Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol. Am J Emerg Med 1993;11(6):576582.
18.Lin, JF, Hsu, SY, Wu, S, Liau, CS, Chang, HC, Liu, CJ, Huang, HL, Ho, YT, Weng, SL, Ko, YL. Data feedback reduces door-to-balloon time in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Vessels 2011;26(1):2530.
19.Purim-Shem-Tov, YA, Rumoro, DP, Veloso, J, Zettinger, K. Emergency department greeters reduce door-to-ECG time. Crit Pathw Cardiol 2007;6(4):165168.
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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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