Proficiency of EKG Interpretation in the Primary Care Setting: A Quality Improvement Initiative

Background: The American Heart Association (AHA) reports that heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States, costing nearly $1 billion daily. An estimated 80% of these cases are preventable; almost 400,000 people in the United States die yearly due to cardiovascular disease. Recent projections estimate that by 2035, 45% of the population will have cardiovascular disease costing the United States $1 trillion annually. Local Problem: Electrocardiogram (EKG) is the gold standard for the diagnosis, assessment, and management of patients with cardiovascular disease (CVD); however, prior studies show low accuracy rates among practitioners. There is a recognized need for improvement in EKG education and advancement in continued learning for all clinicians. This project aims to improve providers' proficiency and confidence in EKG interpretation and subsequent medical decision-making in a non-cardiac care clinic. Methods: This quality improvement project was completed in five phases. First, a per-implementation survey assessed perceived confidence and proficiency in clinicians' EKG interpretation. Next, an education module was created based on the initial survey results. Phase three included an EKG pre-skills test where the clinicians interpreted six distinct EKG rhythm strips, followed by the education module. A post-skills test was then administered to assess learning. In phase four, the clinicians used an algorithm (Colbeck, 2016) to assist EKG interpretation and guide clinical practice. Phase five focused on the usability and sustainability of ongoing EKG education and resources. Finally, a post-intervention survey assessed continued confidence, long-term knowledge retention, and proficiency in EKG interpretation. Results: The EKG skills test was comprised of 6 EKGs with a total of 12 questions. The overall quiz score was computed as the sum of the 12 questions. A paired t-test was utilized to compare pre-and post- knowledge tests. There was a significant improvement in post-scores, with a mean of 5.1 points higher on the post-test. Of those who participated, 80% (n=8) reported that they were either "not confident" or "somewhat confident" before the education. Following the educational module, self-reported confidence 3 improved, with no practitioners (n=0) reporting "Not Confident." Eight weeks post-intervention, while utilizing the algorithm (Colbeck, 2016), 100% (n=10) of clinicians reported being either "confident" or "very confident" in EKG interpretation. Conclusion: This project shows improved EKG interpretation competency and demonstrates the importance of ongoing education in the non-cardiac setting. Long-term knowledge retention is critical to the diagnosis and medical decision-making of cardiac abnormalities.