Improving time to ECG in ambulatory chest pain: a quality improvement initiative in an Irish emergency department.

backgroundTimely electrocardiograms (ECGs) are essential for identifying acute coronary syndrome (ACS), with international guidelines - including those from the European Society of Cardiology (ECS) and American Heart Association (AHA) guidelines recommending a time to ECG (TTE) of less than 10 minutes. However, achieving this in busy emergency departments (ED) is challenging, particularly for ambulatory patients who are not conveyed via ambulance to ED. A baseline audit at Galway University Hospital (GUH) identified prolonged TTE in this group, prompting a quality improvement project (QIP).

methodsUsing ESC, and AHA guidelines standard of ECG within 10 minutes, we implemented a QIP comprising three Plan-Do-Study-Act (PDSA) cycles. The UK Care Quality Commission's (CQC) threshold of ECG within 30 minutes was also measured. Prospective data were collected via rapid-cycle audits from June to September 2024, capturing real-time performance. Educational and workflow measures were introduced to improve TTE.

resultsAcross the three cycles (n=10, n=19, n=16), only 6% of patients achieved TTE within 10 minutes in the final cycle. However, the median TTE improved from 42 minutes at baseline to 14 minutes in the final cycle. Performance against the CQC's 30-minute benchmark improved from 50% in Cycle 1 to 100% in the final cycle.

conclusionsThis QIP demonstrates that meaningful improvement in TTE is achievable despite persistent difficulty meeting the 10-minute target. Context-aware quality metrics may better reflect progress in busy EDs. Future efforts will focus on earlier ECG acquisition in the patient journey, including an exploration of triage redesign and front door ECG capability.