Getting to the heart of the issue: senior emergency resident electrocardiogram interpretation and its impact on quality assurance events

Abstract

Objective Electrocardiogram (ECG) interpretation skills are of critical importance for diagnostic accuracy and patient safety. In our emergency department (ED), senior third-year emergency medicine residents (EM3s) are the initial interpreters of all ED ECGs. While this is an integral part of emergency medicine education, the accuracy of ECG interpretation is unknown. We aimed to review the adverse quality assurance (QA) events associated with ECG interpretation by EM3s. Methods We conducted a retrospective study of all ED ECGs performed between October 2015 and October 2018, which were read primarily by EM3s, at an urban tertiary care medical center treating 56,000 patients per year. All cases referred to the ED QA committee during this time were reviewed. Cases involving a perceived error were referred to a 20-member committee of ED leadership staff, attendings, residents, and nurses for further consensus review. Ninety-five percent confidence intervals (CIs) were calculated. Results EM3s read 92,928 ECGs during the study period. Of the 3,983 total ED QA cases reviewed, errors were identified in 268 (6.7%; 95% CI, 6.0%-7.6%). Four of the 268 errors involved ECG misinterpretation or failure to act on an ECG abnormality by a resident (1.5%; 95% CI, 0.0%-2.9%). Conclusion A small percentage of the cases referred to the QA committee were a result of EM3 misinterpretation of ECGs. The majority of emergency medicine residencies do not include the senior resident as a primary interpreter of ECGs. These findings support the use of EM3s as initial ED ECG interpreters to increase their clinical exposure.

Does Inclusion of Emergency Medicine (EM) Residents in ECG Screening for STEMI Change the Time to Catheterization Lab Activation?

“…Existing studies reveal that resident interpretation of ECGs does not lead to increased quality assurance events. 7 Another small-scale study reports that ECG interpretation performed by physicians in the first year out of practice, and by advanced practice practitioners, has similar sensitivity and specificity to that of attendings with a decade or more of clinical experience. 8 Current research is limited in power and scope; additional studies are warranted to evaluate whether the interpretation of ECGs for STEMI by senior residents in the ED affects throughput to the cardiac catheterization lab (CCL).…”