Improvement of Door to Electrocardiogram Times for Patients Experiencing ST-Elevation Myocardial Infarction; Time-to-Treatment

Background:Coronary heart disease is the leading cause of death among adults in the United States with 30% to 33% of patients with coronary heart disease presenting with ST-elevation myocardial infarction (STEMI) symptoms. Complications and mortality increase the longer a patient experiencing a STEMI is left untreated. Rapid electrocardiogram detection of STEMI is critical and studies have shown that faster door to electrocardiogram time leads to improved management and patient outcomes. The goal of this project focused on improving the door to electrocardiogram time for patients experiencing STEMI, who present to a rural emergency department in Utah to improve patient outcomes. In the pre-implementation months, a mean of 6.88 minutes (SD = 1.45) was the average door to electrocardiogram time with a goal of five minutes. Methods: A quality improvement project was developed and the Plan-Do-Study-Act (PDSA) cycle was utilized to help improve the door to electrocardiogram times within a rural emergency department. The emergency department multidisciplinary team identified barriers to delayed electrocardiograms, a retrospective chart review was collected on all electrocardiograms performed on patients experiencing a STEMI, and mock drills were performed to improve familiarity of the electrocardiogram process. Results:In the post-implementation months, three patients experienced a STEMI. A mean of 8.33 minutes (SD = 6.66) was the average door to electrocardiogram times for these patients who experienced a STEMI. Due to the limited amount of data, and one outlier (door to electrocardiogram of 16 minutes), inferential statistical analysis was not appropriate to perform. Conclusions:Although the project aim was not reached, this quality improvement project demonstrated the effectiveness of team collaboration and establishes a foundation for other emergency departments to use to improve their door to electrocardiogram times through a set of interventions. Therefore, adhering to the interventions that are currently in place is essential in reaching the hospital standards for performing electrocardiograms. Future implications include a new study performed when the newly purchased electrocardiogram machines are within the department.