The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction

A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

“…Hence, various efforts have been made to shorten the DTE time, including designation of an ECG technician and equipment for triage ECG, organization of triage education, improvement of triage disposition, and data feedback 13 . Although assigning a technician and ECG equipment to the conduction of triage ECG has been shown effective for reducing DTE time 8,17,[23][24][25] , indiscriminate ECG screening without a patient interview by an experienced emergency physician has raised the concern of increasing workload among nursing staff as well as the possibility of low cost-effectiveness 16 . Indeed, a previous study has reported a 30% increase in ECG workload after implementation of a triage ECG program 10 .…”

A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

“…Hence, various efforts have been made to shorten the DTE time, including designation of an ECG technician and equipment for triage ECG, organization of triage education, improvement of triage disposition, and data feedback [13]. Although assigning a technician and ECG equipment to the conduction of triage ECG has been shown effective for reducing DTE time [8,17,[23][24][25], indiscriminate ECG screening without a patient interview by an experienced emergency physician has raised the concern of increasing workload among nursing staff as well as the possibility of low costeffectiveness [16]. Indeed, a previous study has reported a 30% increase in ECG workload after implementation of a triage ECG program [10].…”

“…Among them, triage ECG, which is the acquisition of ECG during triage before history-taking by emergency physicians, is widely implemented in the ED setting [4,10,[13][14][15]. However, the downside of triage ECG is that, in addition to the need for setting up ECG equipment, technicians and space in the triage area, indiscriminate ECG for patients with suspected STEMI is not cost-effective and can be time-consuming so that the care for other patients could be delayed [16]. To address this issue, Coyne et al created a "cardiac triage" designation to incorporate triage ECG into an improved patient disposition during the triage process, which has been reported to shorten the DTE time [17].…”

“…To address this issue, Coyne et al created a "cardiac triage" designation to incorporate triage ECG into an improved patient disposition during the triage process, which has been reported to shorten the DTE time [17]. Although this combined approach was successful in reducing DTE time, some concerns, such as the increased workload among medical staff, interruption and distraction at work as well as a high cost of employing specialized personnel with a low yield of STEMI identi cation, were raised in a few studies [16,18].…”

Emergency department Code STEMI patients with initial electrocardiogram labeled “normal” by computer interpretation: A 7‐year retrospective review

“…A number of small studies have highlighted the low yield of triage ECGs for ST‐elevation myocardial infarction (STEMI), 1 suggested that those labeled “normal” by computer interpretation are “unlikely to have clinical significance that would change triage care” 2 and that immediate review “would not have changed these patients’ courses” 3 and hypothesized that ECGs labeled normal or “otherwise normal” would “have no immediate clinical significance.” 4 But another study found conflicting results 5 . There is a proposed paradigm shift from STEMI to occlusion MI (OMI) 6 along with warnings that computer labeled normal ECGs could be missing OMI, 7,8 illustrated by dozens of examples 9 .…”