Door to Electrocardiogram (ECG) Time Improvement Utilizing the First Nurse Role

Abstract

Session H presented Friday, September 28, 2:30-3:30 pm Purpose: Meeting the national standard for door-to-ECG acquisition within 10 minutes of arrival to an emergency department is crucial to ensure prompt treatment for patients suffering from a heart attack. The purpose of this project was to provide training for the first nurse (emergency nurse stationed in the ED waiting room) and improve care for patients seeking treatment for symptoms suggestive of a coronary event. Design: This quality improvement project compared door-to-ECG times for patients presenting with symptoms suggestive of acute coronary syndrome before and after first nurse training. Setting: A private, not-for-profit Community Hospital located in the urban southeastern part of the United States. This quality improvement project was conducted in a 58 bed ED that provides care for approximately 70,000 patients per year. Participants/Subjects: All ED staff participated in this project. All patients included in the ACTION registry-reporting database during the project timeframe were included in the projects’ data comparison. Methods: This project used quantitative data in a quality improvement design that compared door (arrival at the ED) to ECG times (time stamp on the ECG) for patients reported to the ACTION registry before and after first nurse training. The intervention for this project was to provide education to the RNs assigned to the first nurse role that included the importance of remaining in the lobby of the emergency department and how the position can affect patient outcomes. Results/Outcomes: Statistical significance was not achieved utilizing a 2-group t-test. However, when comparing monthly means, data trend lines showed favorable improvement for door-to-ECG time after the intervention. Implications: This project gave insight into the importance of having a nurse stationed in the emergency department waiting room with defined expectations of that role. While the results do not provide statistical significance to support the first nurse role with ECG times, the downward trend of post intervention times are indicative that continued work in this area is projected to result in improved patient care. Discussion occurred within the department regarding how this role impacted multiple areas and made an impact on patient experience and care. As an anecdotal observance, a positive impact was seen on staff ownership of patients in the waiting room and processes involving waiting patients. Staff members have brought up several ideas for improvement including a separate waiting area for lower acuity patients, input for protocols to be used in triage, and discussion over patient prioritization. Future studies could expand the first nurse educational intervention to include other high-risk populations that need rapid intervention upon arrival to the ED including patients suffering from a stroke or sepsis. An expanded project data review could measure indicators for those populations, such as door-to-drug times for stroke or door-to-antibiotic times for sepsis. Continued investigation into the high-risk area of the waiting room is needed to determine which interventions best serve patients entering through the front end of the emergency department. The first nurse role needs further evaluation to determine its effect on benefits for patients and throughput improvement within the emergency department.