Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology Vol. 18; no. 4; pp. 289 - 298
• Main Authors: O’Donnell, Sharon, Monahan, Peter, McKee, Gabrielle, McMahon, Geraldine, Curtin, Elizabeth, Farrell, Sean, Moser, Debra
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2019; Oxford University Press
• Subjects: Acute coronary syndromes; Adult; Age Factors; Aged; Clinical practice guidelines; Cohort Studies; Decision Making, Computer-Assisted; Diagnosis, Computer-Assisted - standards; Electrocardiography; Electrocardiography - standards; Emergency Service, Hospital - standards; Female; Heart attacks; Humans; Ireland; Male; Middle Aged; Myocardial Infarction - diagnosis; Practice Guidelines as Topic; Sex Factors; Time Factors; Triage - standards; Ireland; Door to electrocardiogram; nursing; acute coronary syndrome; technology; emergency department
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1177/1474515118821023

Background:
For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited.
Aims:
The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min.
Methods:
This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses (n=18) who had utilised it.
Results:
The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of ‘immediate ECG’ or ‘ECG within 10 min’ (p<0.001). There was a significant difference in ‘triage to ECG’ times across categories, the ‘immediate ECG’ categorisation resulting in the shortest time (p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate.
Conclusion:
Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.