Honors Theses and Capstones

Date of Award

Summer 2022

Project Type

Capstone

Department

Nursing

Program or Major

Direct Entry Masters in Nursing

Degree Name

Master of Science

First Advisor

Elizabeth Evans

Abstract

BACKGROUND: Timeliness in obtaining an electrocardiogram (ECG) is imperative for patients presenting to the emergency department (ED) with signs and symptoms of acute coronary syndrome (ACS). The American Heart Association (AHA) and American College of Cardiology (ACC) recommend performing an ECG within 10 minutes of patient arrival. Delays in door-to-electrocardiogram (DTE) times were evident in the walk-in (WI) patient population who presented to the ED waiting room (WR) where this quality improvement (QI) project took place. The aim of this QI project was to reduce the median DTE time to 10 minutes through improving the point of contact process upon patient arrival to the ED WR. While beginning work on this QI project it was noted that door greeters/screeners were positioned in the front entrance area of the WR as the point of contact staff member and functioned in a non-clinical role.

METHODS: The Define, Measure, Analyze, Improve, Control (DMAIC) framework was used to guide QI interventions in the process of acquiring an ECG. Staff interviews were obtained and concurrently used with the DMAIC framework in attempts to determine the root causes of delays during the arrival process within the ED WR. Median DTE time data and door greeter/screener surveys were obtained for comparison. Literature was reviewed for current evidence.

INTERVENTIONS: A patient education sign was placed in the ED WR entrance area on the common ACS symptoms with a message for patients to alert the nearest staff member for self-advocation of symptoms. The sign was written in English. A reference sheet was left with the WR entrance door greeter/screener on the common symptoms of ACS with a standardized communication message to use to alert ED clinical staff members of an emergent patient.

RESULTS: Data was collected on median DTE times during the intervention which showed a slight improvement from 12.73 (range 7.27-18.2) minutes to 12.33 (range 7.98-16.67) minutes.

Many limitations existed in the study including a small sample size of two patient’s pre-intervention and two patients post intervention. Data was gathered on adult patients greater than 18 years old with a preferred language of English. Compliance of DTE time within 10 minutes remained unchanged at 50%. The front entrance greeter/screener staff surveys showed improvement in knowledge on communication of emergent patients with ACS symptoms. Qualitative thematical survey responses showed that insufficient staffing and room availability was a large problem contributing to delays.

CONCLUSION: There was a slight improvement in median DTE time, however due to the limited study and timeline constraints there was a small sample size. Further nursing interventions aimed at the point of contact process could prove useful as a future QI project over a longer study period to determine more reliable patterns and statistical significance. Improvements were seen in communication knowledge and survey responses reported staff and room availability as a major cause of delay in obtaining an ECG. Further role expansion in acquisition of timelier ECGs may prove useful in further QI projects as many of staff surveyed had prior medical training but worked in a non-clinical function.

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