Critical Path Network

Get EKG time down to 11 minutes or less

At Loma Linda (CA) University Medical Center, ED nurses have decreased door-to-EKG time to 11 minutes from almost an hour a year ago, reports Teri D. Reynolds, RN, BSN, clinical educator in the department of emergency services.

"We are now experts at getting the patient to the cath lab before 30 minutes," she says.

In January 2007, door-to-EKG time was an average of 50 minutes. Sherry Nolfe, BSN, MICN, core measures resource nurse in the ED, says, "At that point, I implemented an education plan for the nurses and patient care techs. I educated them on the importance of a 10-minute EKG and how it was the only tool we use to identify a STEMI."

By July 2007, door-to-EKG time was down to nine minutes, and it has remained at 11 minutes or less to date. "Our average door-to-reperfusion time for 2007 was 113 minutes and, for 2008, it is 87.5 minutes," reports Nolfe. "I think this is due to our early recognition of [ST-elevation myocardial infarction] STEMI with our EKG times, and also the implementation of our STEMI activation team."

All chest pain patients in Loma Linda's ED are required to receive an EKG within 10 minutes of arrival. All EKGs completed in the ED are then given to an attending to interpret, and if it shows a STEMI, the attending physician activates the STEMI team. "The patient is brought to an ED bed immediately, and the cardiovascular checklist is completed by the nurse," says Nolfe. "Our average for this year is door-to-cardiovascular lab in 26 minutes."