Impact of a new triage tool for screening acute myocardial infarction patients on the door-to-electrocardiogram time in an emergency department

Background and objective

Early diagnosis and treatment of acute myocardial infarction (AMI) have direct implications on clinical outcome. Initial triage has the challenge of being able to identify both typical and atypical cases. The aim of this study was to investigate the impact of implementing a new triage tool in the emergency department on the door-to-electrocardiogram (ECG) time of patients admitted with AMI.

Patients and methods

A total of 50 consecutive AMI patients (mean age 71.0 ± 12.9 years, 76.0% male) were evaluated. Patients were divided into two groups: G1 consisted of 27 patients evaluated in the 4 months before tool implementation (April–July 2006), and G2 consisted of 23 patients evaluated in the first 4 months after tool implementation (August–November 2006). This new triage tool was developed to guide the nurse's decision and was based on three key questions: presence of cardiovascular risk factors, previous atherosclerotic disease (coronary artery disease, stroke, peripheral arterial disease, carotid stenosis, aortic aneurysms, renal artery stenosis), and symptoms on admission. After triage team training, the tool was implemented on 1 August 2006. The door-to-ECG time was prospectively measured from the time of patient arrival in the emergency department to the time of initial ECG acquisition (minutes). Statistical analysis was performed using Student's t test. P < 0.05 was considered statistically significant.

Results

The comparison between groups found a significant decrease in the door-to-ECG time in the post-implementation period (P = 0.00002) (Table 1).

Table 1 (abstract P47)

Conclusion

The implementation of this new triage tool had a significant impact on reducing the door-to-ECG time and it may become a useful tool for identifying atypical AMI patients.