Triage of patients for a rapid (5-minute) electrocardiogram: A rule based on presenting chief complaints

Graff, Louis; Palmer, Antonetta Carlone; LaMonica, Patricia; Wolf, Steve

doi:10.1067/mem.2000.111057

Cited by 56 publications

(16 citation statements)

References 20 publications

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“…However, this was at the cost of performing 1% more ECGs in all ED patients (from 6.3 to 7.3%). 26 We noted that in crowded EDs, triage ECGs may further delay the triage of other patients, particularly if they require time for the triage nurse to show the ECG to the physician. Like cardiac Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Atzema

Austin²,

Tu³

et al. 2011

CJEM

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Objective: The American Heart Association (AHA) recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial infarction patients, but this is based on expert opinion (level of evidence C). We sought to establish an evidence-based benchmark door-to-ECG time.Methods: This retrospective cohort study used a populationbased sample of patients who suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 and 2001. Using cubic smoothing splines, we described (1) the relationship between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI patients who met the benchmark door-to-needle time of 30 minutes based on their door-to-ECG time. We hypothesized nonlinear relationships and sought to identify an inflection point in the latter curve that would define the most efficient (benefit the greatest number of patients) door-to-ECG time. Results: In 2,961 STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 minutes, respectively. There was a linear increase in ECG-to-needle time as the door-to-ECG time increased, up to approximately 30 minutes, after which the ECG-to-needle time remained constant at 53 minutes. The inflection point in the probability of achieving the benchmark door-to-needle time occurred at 4 minutes, after which it decreased linearly, with every minute of door-to-ECG time decreasing the average probability of achievement by 2.2%. Conclusions: Hospitals that are not meeting benchmark reperfusion times may improve performance by decreasing door-to-ECG times, even if they are meeting the current AHA benchmark door-to-ECG time. The highest probability of meeting the reperfusion target time for fibrinolytic administration is associated with a door-to-ECG time of 4 minutes or less.

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Section: Discussionmentioning

confidence: 99%

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Atzema

Austin²,

Tu³

et al. 2011

CJEM

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show abstract

“…Their chief complaint is less likely to be chest pain and is more likely to be syncope, weakness, or shortness of breath. 1,6 These symptoms are more nonspecific, may suggest a range of diagnoses, and thus are more challenging for the emergency physician to interpret. Patients with an atypical presentation of AMI are more frequently misdiagnosed on admission, and less frequently receive evidence-based therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The patient's risk of death is doubled, 2,3 and such events are the leading cause of malpractice suits in EM. 4,5 Failure to diagnose AMI occurs because many patients present atypically, 1,6 without positive electrocardiography or cardiac biomarker tests in the emergency department (ED). 7,8 A related quality-of-care problem is the delay in AMI diagnosis for patients admitted to the hospital.…”

mentioning

confidence: 99%

Delay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment

Graff

Wang

Borkowski

et al. 2006

Academic Emergency Medicine

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“…The time delays to initial ECG and to administration of thrombolytics have been shown to correlate with outcome. According to Graff et al, 29 in a four-year study period, outcome improved after the implementation of the standing rule for ordering immediate ECGs. The mean delay in performing ECGs in MI patients administered thrombolytics decreased from 10.0 minutes to 6.3 minutes and the mean delay in administering thrombolytics decreased from 36.9 minutes to 26.1 minutes.…”

Section: What Are the Barriers To Quality Improvement?mentioning

confidence: 99%

Measuring and Improving Quality in Emergency Medicine

Graff

2002

Academic Emergency Medicine

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The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as ''the care health professionals would want to receive if they got sick.'' The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.

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Triage of patients for a rapid (5-minute) electrocardiogram: A rule based on presenting chief complaints

Cited by 56 publications

References 20 publications

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Delay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment

Measuring and Improving Quality in Emergency Medicine

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