Dramatically cut delays in review of an EKG
Comply with 'five-minute rule'
While the EKG is done immediately upon a chest pain patient's arrival at Huntsville (AL) Hospital, it still must be reviewed by the ED physician within five minutes.
"In a busy ED, this is challenging," says James Noland, CRNP, BC- PNP, MSN, CEN, CCRN, an ED nurse practitioner. "ED physicians are constantly evaluating patients, performing procedures, consulting other physicians, interpreting X-rays, and documenting patient findings."
The EKG is presented to an ED physician to review and initial, time, and interpret within five minutes of completion. "The most frequent challenge is interrupting the physician to evaluate and sign the EKG," says Noland.
At times, new staff members might not be aware of the timeline restriction and don't get the EKG to the physician within the five minutes. "However, this happens infrequently," says Noland. "ED physicians are constantly teaching and reminding everyone of the importance of complying with the five-minute rule."
Care is uninterrupted
The Trauma & Emergency Center at Bronson Methodist Hospital in Kalamazoo, MI, had timed trials with staff acting as patients, to decrease delays for the treatment of ST-elevation myocardial infarction (STEMI) patients, says Alison Hofheinz, MSN, CNS, STEMI coordinator and clinical nurse specialist.
One challenge was to quickly obtain the 12-lead EKG, but the other challenge was getting it to the ED physician immediately after completion to assist with early diagnosis.
"We found that doing the 12-lead in the triage bay was far quicker than moving the patient to the room, even if we had a bed open," says Hofheinz. "This way, the patient care technician has the 12-lead in hand when taking the patient back through the department into a treatment room."
The patient care assistant is the one who brings the EKG to the ED physician. "This way, the ED nurse can provide uninterrupted care for the patient," says Hofheinz.
As the patient is being transported, a page goes out to the caregivers on the team, "Chest Pain patient going to room #___." The triage patient care technician then hands off the 12-lead EKG to the provider.
"This is done either on the way to the room, as they should also be moving in that direction to see the patient, or in the patient room," says Hofheinz. "If not, after leaving the patient with the team, the primary responsibility of the patient care technician becomes getting the 12-lead to the provider."
While the EKG is done immediately upon a chest pain patient's arrival at Huntsville (AL) Hospital, it still must be reviewed by the ED physician within five minutes.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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