Improvement Project to reduce wait-times for initial ECG examination for chest pain patients presenting in ED

Saturday, 16 November 2013

Su-Chen Tsai, RN
Li-Hsnan Yu, RN
Nursing Department, Cheng Hsin General Hospital, Taipei, Taiwan

Learning Objective 1: To understand how interdisciplinary teams from Cardiology and Emergency departments can incorporate digital communications and coordinated human resources to reduce delays in initial ECG examinations.

Learning Objective 2: To increase awareness amongst ED nurses to proactively identify chest pain patients and administer ECG examinations within ten minutes of patientsí arrival in the ED.


ECG (Electrocardiograph) examination is the critical step for Emergency Department (ED) physicians to determine if chest pain poses a life-threatening condition prior to medical decisions and treatment. According to Taiwan’s national “Hospital Emergency Medical Care Capability Rating Standard,” the first ECG examination should be conducted in less than ten minutes for 70% of chest pain patients who present in the ED. Prior to the formation of an interdisciplinary team approach, the average performance of the ED was 17.9 minutes, and only 50% of patients presenting chest pain received an ECG examination in less than ten minutes. To improve ED performance in administering ECG examinations, a interdisciplinary team consisting of physicians and nurses from Cardiology and Emergency departments was formed to improve processes, appropriately adjust human resources, acquire additional equipment, and distribute ECG examination results in real-time to on duty attending cardiology physicians' mobile devicesUpon implementation of these new procedures, the average time for ECG examination has been reduced to 8.9 minutes with 75.4% of chest pain patients receiving the examination in less than ten minutes. In addition, the project reduced the median time of door to balloon (D2BT) for acute ST segment elevation myocardial infarction (STEMI) patients to 68 minutes. Overall, 81% of STEMI patients achieve D2BT in less than 90 minutes, which exceeds the 75% in 90 minutes current treatment guideline recommendation for quality of care requirement in Taiwan.