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How to Reduce Door-to-ECG Times

By Shane Elmore, RN

Fewer things are more frustrating for a medic than calling in a STEMI. First, they have to send the ECG in for the physician to see before they arrive at the hospital, and then they are asked to stop at the door to get another one using the hospital’s ECG machine. When they could be out saving more lives, duplicating their efforts is the last thing they want to be doing. This practice also slows your hospital's door-to-ECG times, and therefore your overall time-to-treatment as well.

There used to be a time when prehospital ECGs were lacking in quality compared to those obtained using hospital machinery. Field ECGs simply weren't of diagnostic quality - but today's field monitors have come a long way, and are now of comparable quality to hospital machinery. As such, it no longer makes sense to require medics to repeat their ECG upon hospital arrival.

So why is the practice of duplicating the ECG so commonplace still? One reason is the common misconception that the hospital is required to print the ECG with their own machinery to capture the metric of “Door to ECG.” This idea is, frankly, just plain wrong.

So what can you do? As soon as you have an ECG, regardless of whether it was sent to the hospital prior to arrival or printed upon EMS arrival, show it to a physician and have them sign it and put a time and date on it. Submit this ECG to Medical Records.

Submitting a signed ECG as soon as you can get your hands on it, especially if it’s before the medic even arrives, will work wonders for your average door-to-ECG times! A door to ECG time of zero is impressive data that can really help your facility when reporting. But, the big kicker here is that you MUST have a process that ensures that this ECG gets to Medical Records every single time ... otherwise it will appear as if you didn’t do one at all.

If you do insist on having the ECG printed in the hospital, be sure to have EMS keep their monitors on and have them push print when they roll through the door. This is the best practice for two reasons:

1. Changing ECG machines can change subtle things about the ECG itself that aren’t actually reflective of changes in the patient. 
2. Taking a patient off of the EMS monitor, and transferring to your own will waste valuable time … and time is the most important factor in a STEMI case. 

There is, however, one good reason to obtain a second ECG: poor lead placement. Unfortunately, poor placement does happen sometimes, and this is especially true in obese patients.

In the end, questioning everything we do to make sure all steps are warranted can save your patient several minutes, thereby saving them valuable tissue as well. The tireless pursuit of excellence is the only way to continuously improve. So, the next stretcher that rolls through your ambulance bay with a STEMI, take a few seconds to stop and think. Those few seconds will translate to minutes of treatment time, and your patient will thank you! #ItsAboutPeople.
ARTICLE CATEGORIES: STEMI
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Shane Elmore, RN

Shane Elmore, RN

Shane is Pulsara's Vice President of Clinical Innovation, and is certified in CCRN, CEN, and CFRN. Shane is a former Chest Pain Coordinator at Trinity Mother Frances Health System.

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