Improving Door-to-ECG Time for Patients Presenting With Chest Pain in the Adult Emergency Department

Friday, 28 July 2017

Barbara Maliszewski, MS1
Heather Gardner, MS1
Diana Lyn Baptiste, DNP, MSN, RN2
Cathleen Lindauer, MSN, CEN1
(1)Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
(2)Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA


The American Heart Association/ American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients who present with chest pain. Reducing ECG-to-door time is important so that health care providers adhere to the recommended door-to-balloon times (less than or equal to 90 minutes) for patients who present with ST-segment elevation myocardial infarction (STEMI).

The objective of this quality improvement project was to measure the mean time that it takes to obtain an electrocardiography (ECG) for patients who present to the emergency department with complaints of chest pain. The goal of this project was develop and evaluate an intervention that promote meeting the American Heart Association/ American College of Cardiology standard for ECG-to-door time of less than 10 minutes upon patients’ arrival to the emergency department (ED).


We implemented a door-to-ECG protocol that included moving the ECG station to a specialized area in triage, where patients can quickly receive an ECG upon arrival to the ED. Patients who presented to the ED with complaints of chest pain were provided with a red heart symbol as an indicator for clinical technicians to identify those in need of an ECG, and process them quickly. Pre and post intervention data was collected over a six-month period.


Prior to the intervention, the mean door-to-ECG time was 21minutes among (N=292) patients over three months. After the intervention, the mean door-to ECG time for (N=701) patients was 10.6 minutes, over the next 3 months. Initially, the percentage of compliance with door-to ECG standard was 26% and improved to 73% after implementation of the door-to ECG protocol. We found that door-to-EKG times for patients who walked in to the ED were relatively shorter than those who arrived via ambulance.


The overall door-to-ECG compliance improved by 47% in the post intervention period. By implementing a door-to ECG protocol, we not only improved door-to ECG-times, potentially decreasing door-to-balloon times for patients who presented with STEMI. Door-to-EKG times may vary among method of arrival. Further investigation is warranted to evaluate door-to-balloon times for patients with STEMI, and for development of strategies to improve door-to-EKG times for patients arriving via ambulance.