Evidence map›Paper›PMID 28174175›Full record

Trial reportCirculation. Cardiovascular quality and outcomes2017

Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial.

Marjorie Funk, Kristopher P Fennie, Kimberly E Stephens, Jeanine L May, Catherine G Winkler, Barbara J Drew, PULSE Site Investigators

Erratum issued Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation. Cardiovascular quality and outcomes, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT01269736 (Implementation of Practice Standards for ECG Monitoring), which is not on this map. Cited by 22 papers.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01269736 nacompletednot on this map

Implementation of Practice Standards for ECG Monitoring

TypeinterventionalSponsorYale UniversityRan2008 to 2014Enrolled92,057ConditionsCardiovascular DiseaseArmsEducation
3 · Its place in the literature

Who cites it

22 citing papers in PubMed.

  1. Trial
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  12. Review
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  16. Atrial Electrography for Postoperative Tachyarrhythmia Analysis in Patients.The Journal of innovations in cardiac rhythm management · 2021
    Article
  17. Monitor-Watcher Use, Nurses' Knowledge of Electrocardiographic Monitoring, and Arrhythmia Detection.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Marjorie FunkFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.). marjorie.funk@yale.edu.
Kristopher P FennieFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
Kimberly E StephensFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
Jeanine L MayFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
Catherine G WinklerFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
Barbara J DrewFrom the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
PULSE Site Investigators

Funding

Yale Study Support Suite (YES3): Dashboard and Web Portal Software Supporting Research Workflow through integrated, customizable REDCap External ModulesP30AG021342 · NIA · YALE UNIVERSITY · PI Denise Esserman · 2002 to 2026
$37.9M
Implementation of Practice Standards for ECG MonitoringR01HL081642 · NHLBI · YALE UNIVERSITY · PI FUNK, MARJORIE · 2008 to 2012
$3.8M
NHLBI NIH HHS R01 HL081642NIA NIH HHS P30 AG021342
6 · The paper itself

Abstract

backgroundAlthough continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. METHODS AND

resultsThe PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained.

conclusionsOnline ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736.

Indexed as

Health Knowledge, Attitudes, PracticeOutcome Assessment, Health CarePractice Guidelines as TopicQuality Indicators, Health CareAdultAgedAttitude of Health PersonnelCardiologyCardiology Service, HospitalClinical CompetenceCross-Over StudiesEducational StatusEducation, Nursing, ContinuingElectrocardiography, AmbulatoryFemaleGuideline Adherenceelectrocardiographynursingoutcome assessment (health care)quality of health carerandomized controlled trial

Identifiers

PMID28174175
PMCPMC5341740

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.