Royal Columbian Hospital and Eagle Ridge Hospital
Academics

Door to ECG

This study is being conducted to determine if having an ECG performed on patients presenting to the emergency department (ED) with symptoms suggestive of ischemic chest pain at triage could reduce arrival to ECG time and arrival to treatment (door to balloon) time.

Lifepak 15

ECG at ED Triage for Ischemic Chest Pain Patients

We are conducting this study to determine if having an ECG performed on patients presenting to the emergency department (ED) with symptoms suggestive of ischemic chest pain at triage could reduce arrival to ECG time and arrival to treatment (door to balloon) time.

Research Team

 

  1. Dr. Amy Cheng, MD, FRCPC (Emergency), MBA
    Clinical Assistant Professor, Dept of Emergency Medicine, UBC
    Staff Physician, Emergency Medicine, Royal Columbian Hospital & Eagle Ridge Hospital
  2. Ms. Mary Van Osch, RN, MSN
    Clinical Nurse Specialist, Fraser Health Emergency Program
  3. Dr. Adam Lund, BSc, MDE, MD, FRCPC (Emergency)
    Clinical Associate Professor, Dept of Emergency Medicine, UBC
    Staff Physician, Emergency Medicine, Royal Columbian Hospital & Eagle Ridge Hospital
  4. Ms. Helen Elliott, RN
    STEMI Program Coordinator, Fraser Health Authority
  5. Mr. Anthony Bryson, BSc, MSI (UBC MD Class of 2014)

 

Background:

Prompt diagnosis of ST elevation myocardial infarction (STEMI) can significantly reduce time to treatment, which improves patient survival. An initial ECG performed after the patient’s arrival in the ED is critical to the diagnosis of a STEMI. Currently, BC advanced care paramedics can perform and interpret (with computer assistance) ECGs on patients with ischemic chest pain. For patients who arrive in the ED as a “walk-in”, or with an ambulance crew who do not have the capability to do a 12 lead ECG, the situation is more challenging, requiring the cardiology technician to be paged to the ED. The American Heart Association currently recommends a door to ECG time of less than 10 minutes, which is achieved in only 30%-40% of patients in hospital across North America.

Purpose. To study whether having trained ED staff perform an initial 12 lead ECGs using Medtronic Lifepak 15 and LifeNet “Solution” STEMI technology on adult walk-in patients presenting with symptoms suggestive of cardiac chest pain at triage will reduce the door to ECG time and door to balloon time in STEMI patients.

Hypothesis:

Training ED staff (emergency nurses, LPNs and emergency room attendants, who are trained paramedics) to perform an initial 12 lead ECG on adult patients presenting to the ED with symptoms suggestive of ischemic chest pain will reduce the door to ECG time, the time to diagnosis by the Emergency Physician, the door to needle time and the door to balloon time in STEMI patients.

Inclusion & Exclusion Criteria:

Inclusion:

  • Adult patients 19 years of age and over
  • Presenting complaint of chest pain or symptoms suggestive of ischemic heart disease
  • Patients in whom an ECG to rule out a STEMI is deemed necessary by the triage nurse and/or the ED physician

Exclusion:

  • Patients under 19 years of age
  • Primary presenting complaint at triage is not symptoms suggestive of possible ischemic heart disease
  • Associated trauma, cardiac arrest, environmental injuries
  • Patients in whom a diagnosis of STEMI, NSTEMI or unstable angina has already been made for the presenting complaint
  • Patients who are being transferred to RCH from a peripheral hospital or directly by EMS for definitive ACS care
  • A diagnostic ECG has already been obtained by the transporting EMS for the current visit

Study Process

  1. The Triage RN ordering the ECG will alert the designated ED staff (emergency nurses and emergency room attendants) to acquire the initial screening 12 lead ECG using the Medtronic LP15. Study subjects must meet inclusion criteria and do not have any of the study exclusion criteria- see above
  2. A regular ‘Hospital’ ECG must still be entered by Triage RN/ Unit clerk and completed for all patient (unless patient is diagnosed as STEMI and being transferred immediately to RCH cath lab).
  3. A delayed consent will be obtained by Helen Elliott, STEMI coordinator post heart cath procedure.
  4. Trained ER staff (At RCH- Emergency Room attendants and ER LPNs) complete a ‘screening’ 12 lead ECG using LifePak 15 Medronic LifeNet system in designated stretcher/ care space.
  5. ER staff MUST show all ECG strips to attending Emergency Room Physician for final interpretation and decision to treat. LP15 12-lead ECG interpretation and STEMI activation must be done by, and only by, the attending Emergency Physician

Potential Impact:

If the study demonstrates that a dedicated health care professional performing a 12 lead ECG at triage can decrease door to ECG and ultimately door to treatment time of STEMI patients, it will provide a novel method to improve the care of STEMI patients in the emergency room setting.