Do you always obtain an EKG under 10 minutes?
Obtaining an EKG in a timely manner is critical, says Brian W. Selig, MHA, BSN, RN, CEN, NE-BC, nurse manager of the ED at the University of Kansas Hospital in Kansas City, MO, "especially with the recent emphasis on time-critical diagnosis by the Joint Commission and [the Centers for Medicare & Medicaid Services.]"
At University of Kansas Hospital, ED nurses strive for a door-to-balloon time on ST-elevation myocardial infarction patients of less than 60 minutes, says Selig. "One of the initiatives that we have put into place to help achieve this is the need to have a door-to-EKG time on all patients of under 10 minutes," he says.
Any patient with a complaint or presenting symptoms that qualify as acute coronary syndrome (ACS) gets an EKG completed and read by a physician within 10 minutes of their arrival to the ED, says Selig. These patients are included:
- Atraumatic chest pain less than 24 hours old;
- Any patient with any chest pain and two or more associated symptoms, including nausea, vomiting, shortness of breath, or diaphoresis;
- Any patient with chest pain with risk factors of smoking, age over 65, family history, high cholesterol, diabetes, hypertension, known drug abuse, or known cardiac history;
- Any patient with known heart disease, diabetes, or age over 70 with atypical symptoms of abdominal pain, dizziness, fainting, shortness of breath, weakness, nausea, vomiting, diaphoresis, palpitations, altered mental status, upper extremity pain, jaw pain, or upper back pain.
"While some of these may seem typical, many times the symptoms are overlooked because the patient doesn’t seem to be in distress," says Selig.
Patients may present with atypical symptoms, says Selig, such as women older than 40 years with shortness of breath, nausea, dizziness, or syncope, any patient with syncopal episodes, overdose, or seizures. Here are two ways that the University of Kansas Hospital’s ED nurses get quick EKGs:
A technician can complete an EKG even before the patient is triaged, in a room next to the entrance.
"The physician can be reading it while the patient is getting the rest of their triage completed," says Selig. "Even during times where the ED is full, we are still able to make our 10-minute door-to-EKG time."
ED technicians and nurses are both trained to complete EKGs.
"Oftentimes, it takes a long time to get the house EKG tech to come to the ER to do a stat EKG," says Selig. "There is virtually no way to meet the door-to-EKG time if you are calling someone from outside of the unit to come to your ED to get it done." (See related story, below, on inclusion criteria for an ED’s chest pain pathway.)
For more information on reducing delays in obtaining EKGs, contact:
- Ann Heywood, RN, MSN, CEN, SANE, Trauma Nurse Coordinator, CVPH Medical Center, Plattsburgh, NY. Phone: (518) 562-7378. Fax: (518) 562-7950. E-mail: AHeywood@cvph.org.
- Brian W. Selig, MHA, BSN, RN, CEN, NE-BC, Nurse Manager, Emergency Department, The University of Kansas Hospital, Kansas City. Phone: (913) 588-6506. E-mail: email@example.com.
Possible MI? ED nurses use this inclusion criteria
Triage nurses at CVPH Medical Center’s Emergency Care Center in Plattsburgh, NY, use an acute coronary syndrome screening tool for patients presenting with chest pain, according to Ann Heywood, RN, MSN, CEN, SANE, trauma nurse coordinator.
If the patient meets the inclusion criteria listed below, says Heywood, nurses follow the chest pain pathway, which includes an EKG within 10 minutes of arrival.
"Exclusion criteria are recent history of trauma, visible lesions, palpable lesions of the skin or chest wall, and isolated breast disease," says Heywood.