Prehospital Electrocardiography: A Review of the Literature

Introduction The American Heart Association and other scientific guidelines recommend emergency medical services acquire prehospital (PH) electrocardiography (ECG) in all patients with symptoms of acute coronary syndrome. The purpose of this article is to critically review the scientific literature about PH ECG. Methods Using multiple search terms, we searched the PubMed and Web of Science databases for relevant information. Search limiters were used: human, research (clinical trials, experimental), core journals, and adult. All articles about the clinical effects of PH ECG published between 2001 and 2011 were retained, in addition to a landmark study from 1997. Results Our search yielded a total of 105 articles when all years of publication were considered. When the same search was limited to articles published between 2001 and 2011 for new and current data, 45 articles were returned. A total of 7 articles about the clinical effects of PH ECG were retained for this review. Articles were conceptualized and organized by clinical effects of PH ECG (timing, reperfusion rate, death, ejection fraction, reinfarction, and stroke). PH ECG has been associated with reduced PH delay time, increased use of reperfusion interventions, earlier diagnosis, and faster time totreatment. Discussion PH ECG plays a major role in emergency cardiac systems of care and can facilitate early intervention by identifying patients with acute coronary syndrome sooner.

Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department

Introduction Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS. Methods We implemented rapid triage assessment integrating the Emergency Severity Index and fast track guidelines in our pediatric emergency department. Arrival-to-triage times were tracked for 1 month before and after the intervention (N = 13,910 patient visits) by recording the time the patient arrived in the department and time triage assessment was complete. Fast track utilization and LWBS rates were measured for all patients sequentially included in pre-intervention (n = 60,373) and postintervention (n = 67,939) groups for 10 months. Results After the intervention, patients experienced a significant decrease in arrivalto-triage times compared with the pre-intervention group (P < .001), with most patients (88.3%) being triaged in less than 10 minutes after the intervention. Following implementation of fast track guidelines, patients were 14% more likely to be triaged to fast track compared with pre-

intervention patients (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.11-1.67). Additionally, patients with the lowest acuity were nearly 50% more likely to be triaged to fast track compared with pre-intervention patients (OR = 1.48, 95% CI = 1.35-1.63). Although LWBS rates were insignificant, overall acuity level of this group was lower in the postintervention group. Discussion Although LWBS rates did not decrease with the intervention, implementation of a rapid triage system and fast track guidelines reduced arrival-to-triage times and decreased acuity in the LWBS population. Implementing rapid triage and fast track guidelines can affect nursesensitive patient outcomes related to safety and care delivery in a pediatric emergency department.