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Abstract
Aims and Objectives Following a recent CQC inspection it was highlighted that the delays to an initial ECG in patients presenting with chest pain caused an unacceptable risk to patient safety. It was our aim to reduce time to ECG from a pre study median of 78 minutes to under 30 minutes as per CQC recommendations.
Method and Design We have utilised approved quality improvement methodology to evaluate the problem and to highlight suitable avenues for sustained improvement. Process mapping and staff surveys revealed a number of avenues to initially explore. Concern over the number of potentially unnecessary ECGs being requested was raised by both medical and nursing staff members. Availability of triage and assessment cubicles in times of crowding, as well as low numbers of Clinical Support Workers (CSW) were also identified as avenues for improvement.
Four interventions were implemented during the project. Recruitment of band 3 CSW was prioritised by senior nursing and management teams. Additional training for new nursing and medical personnel was initiated. Presentations mandating an ECG from triage were discussed and local agreed policy implemented. A Continuous Flow Model (CFM) was introduced in the trust aimed to reduce crowding within the emergency department and improve cubicle space that can be utilised for triage or performing investigations.
Results and Conclusion Median time to ECG at baseline was 78 minutes, at worst (data-point 3) was 100.5 minutes and at most improved (data-point 7) was 29 minutes, demonstrating a statistically significant improvement (p=0.004). Run-chart data demonstrated sustained improved performance, below the level of quartile 1 from data-point 3, for 6 consecutive points demonstrating a shift. Continued improvement may be achieved by recruiting ECG technicians, and transition to a new department building.
