The Advantage of Improving Door to Electrocardiogram (ECG) Times for Chest Pain Patients

Introduction

Both the American Heart Association and the American College of Cardiology require electrocardiogram to be conducted and the obtained results interpreted within the shortest time possible from the time when a patient experiencing chest discomfort arrives at the emergency department. Electrocardiography involves the use of the conventional electrocardiography to measure and record the electric activity of the patient's heart. The goal of electrocardiography is to determine the degree of electricity applied to or produced by the heart (Luna, 2012). A lot of research has been done about the door to electrocardiogram time in patients experiencing chest pain. The American Heart Association requires emergency departments to conduct electrocardiogram within the first ten minutes after the arrival of the patient. Some patients experience delays in undergoing an electrocardiography. Some of the factors that contribute to the delay include the need to wait for a long time before being attended to, undertriage, and the inadequacy of space or staff to the facility a rapid ECG. One of the ways of reducing the door to ECG time involves allowing the patient to bypass triage by going directly for an ECG investigation. This paper seeks to examine the advantage of improving the door to electrocardiogram time for patients admitted with chest pain.

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The first advantage of improving the amount of time a patient waits to undergo ECG is that it helps in enhancing the adherence of the medical practitioner to the required door-to-balloon time. The American Heart Association requires an emergency department to adhere to a door-to-balloon time of 90 minutes. A lot of studies have been done to determine how the door to balloon time can be improved and one of the recommendations has been improving the door to ECG time for chest pain patients. The door to balloon time is made up of the door to electrocardiogram time, the electrocardiogram to catheterization activation time, catheterization activation to catheterization door time, and the catheterization to door to catheter access time (Levis, Mercer, Thanassi, & Lin, 2010). Since the door to electrocardiogram time is the first in the process, it impacts more on the total door to balloon time. When the door to ECG time is improved, all the other steps in the process will be performed without delay. Reducing the door to balloon time helps in the reduction of mortality, enhancing the functioning of the left ventricular, and a decline in the number of future admissions involving heart failure.

Takakuwa and colleagues carried out a study to investigate the effect of improving door to ECG time on the door to balloon time. To conduct the research, they adhered to a door to ECG time of ten minutes. The door to ECG time for all patients that complained of chest pain was tracked. The study revealed that improving the door to ECG time played an important role in reducing the total door to balloon time, thus facilitating positive treatment outcomes (Takakuwa, Burek, Estepa, & Shofer, 2009). However, the findings indicated that adhering to the door to ECG time of 10 minutes only helped in reducing the door to balloon time with the presence of the catheterization team on the site, and better outcomes could not be achieved during the nights and weekends when the team was not on the site. It implies that a focus on improving the door to ECG time should only include the enhancement of the availability of other medical practitioners that are responsible for performing the other therapies that come after the ECH. Reducing the time is achieved through increased staffing.

Second, improving the door to electrocardiogram time helps in reducing the time for other therapies, such as cardiac catheterization. Cardiac catheterization cannot be conducted before the completion of electrocardiography. The treatment is used to treat health complications once they have been identified. The results from the ECG are used to determine whether the patient's artery is completely or partially blocked. Cardiac catheterization is only conducted when the ECG results show that the patient has completely blocked the artery that needs to be opened using balloon angioplasty (Crandall, 2013). A delay in obtaining the results of the ECG leads to a delay in cardiac catheterization. When chest pain patients are helped to go through cardiac catheterization early enough, they are more likely to embark on their normal activities and after accepting a non-cardiac cause of their symptoms. However, a delay in the process may lead to adverse effects, such as time. According to a study by Natarajan and colleagues, the delay in conducting the cardiac catheterization process was responsible for most of the patients that died from chest pain because of the delay in the time taken to unblock the blocked artery (Natarajan, Mehta, & Holder, 2002). Improving the door to ECG time facilitates early cardiac catheterization, thus reducing the risk of death.

Reducing the arrival to ECG time facilitates early thrombolysis in chest pain patients. A patient undergoes thrombolysis is only after the ECG results have been obtained. The purpose of administering thrombolytic drugs is to break down any thrombus that could be blocking the coronary artery. It is recommended that the administration of thrombolytic drugs should be within 60 minutes from the time when the chest pain patient calls for help and within 30 minutes from the time when the patient arrives at the health facility. Improving the time for ECG leads to a decline in the door to drug time and other asymptote effects. An increase in the door to ECH time leads to a delay in thrombolysis, thus increasing the risk of death and health complications. Research shows that the rate of death among patients who receive thrombolytic drugs within the stipulated time is one third less compared to those who receive the drugs at a later time or those who are not given the drugs at all. (Brooker, Nicol, & Alexander, 2011) Thus, it is important to improve the door to ECG time to ensure that patients with chest problems and have freshly formed thrombus in the coronary artery are given thrombolytic drugs early enough to break down the thrombus and reduce the risk of death due to a blocked artery.

Lastly, improving the door to electrocardiogram time contributes to positive clinical outcomes, such as early percutaneous coronary intervention. Percutaneous coronary intervention is used in treating chest pain patients to open up the coronary artery, which is responsible for supplying oxygen and blood to the heart muscles, to restore the flow of blood. It is emergency treatment, implying that it is supposed to be performed within the shortest time possible from the time when the chest pain patient arrives at the health facility, to reduce the amount of the muscles of the heart that could have been damaged by the attack causing the chest pain. Early percutaneous coronary intervention (PCI) has been found to enhance the clinical outcomes for chest pain patients. Some of the ways of promoting early percutaneous coronary intervention (PCI) include improving the door to electrocardiogram time and the immediate interpretation of the electrocardiogram results (Coyne & Testa, 2015). The advantages of early percutaneous coronary include preventing the occurrence of more damage to the heart muscles, thus reducing the risk of death. Early percutaneous coronary also helps in increasing the positive treatment outcomes, which is important in preventing future complaints of chest pain among the chest pain patients.

Conclusion

In conclusion, improving the door to electrocardiogram time in chest pain patients plays a significant role in facilitating positive treatment outcomes. Chest pain patients are required to undergo electrocardiography within the first ten minutes of arrival at the health facility and the total door to balloon time should not be more than 90 minutes. Improving the door to ECG time facilitates the adherence to the door to balloon time of 90 minutes in addition to ensuring that each of the therapies required in the treatment process is conducted as early as possible to achieve positive clinical outcomes. A shorter door to ECG time facilitates early percutaneous coronary intervention, early admission of thrombolytic drugs, and cardiac catheterization at the right time, which are some of the essential and critical processes in the diagnosis and treatment of chest pain patients. It is, therefore, important for medical practitioners to adhere to the stipulated door to ECG time to achieve positive clinical outcomes and enhance the health of chest pain patients.

A lot of research has been done to determine when ECG should be carried out from the time a patient with chest complications arrives at a medical facility. According to the American Heart Association, medical practitioners should adhere to a door to ECG time of ten minutes. However, there are several factors that may limit the adherence to the stipulated time. Some of the factors include inadequate staffing, undertriage, and the inadequacy of space. Despite the challenges, and emergency department should be committed to improving the door to ECG times. Shorter door to ECG times are of advantage to the treatment process of chest pain patients.

The advantages of improving the door to ECG times include facilitating the adherence to the a door to balloon time of 90 minutes and ensuring that other therapies involved in the treatment process, such as cardiac catheterization, thrombolysis and percutaneous coronary intervention, are carried out at the right time. ECG first stage in the diagnosis of the patients, thus improving the ECGT time will contribute to a shorter door to ECG time, thus enhancing treatment outcomes. Concerning other therapies in the treatment process, some therapies, such as cardiac catheterization is only carried out when the results of ECG have been obtained and interpreted. Improving the time helps to ensure that the determination of the need for the therapy is early enough. For example, the delay in the breakdown of the thrombus that could be blocking the coronary artery in the patients could lead to increased damage of the heart muscles, thus increasing the risk of negative clinical outcomes, such as death. Information on the time taken to take the patient through ECG can be obtained from the nurses by either interviewing them or examining the medical records in the hospital.

References

Brooker, C., Nicol, M., & Alexander, M. F. (2011). Alexander's Nursing Practice4: Alexander's Nursing Practice. New York, USA: Elsevier Limited.

Coyne, C. J., & Testa, N. (2015). Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients. Western Journal of Emergency Medicine, 16(1), 184-189.

Crandall, C. (2013). The Simple Heart Cure: The 90-Day Program to Stop and Reverse Heart Disease. Qwest Palm Beach, USA: Humanix Books.

Levis, J. T., Mercer, M. p., Thanassi, M., & Lin, J. (2010). Factors Contributing to Door-to-Balloon Times of 90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol. The Permanente Journal, 14(3), 4-11.

Luna, A. B. (2012). Text book of Clinical Electrocardiography. Dordrech...