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Comparing physicians and experienced advanced practice practitioners on the interpretation of electrocardiograms in the emergency department

Published:January 27, 2020DOI:https://doi.org/10.1016/j.ajem.2020.01.047

      Abstract

      Background

      Many patients present to emergency departments (ED) in U.S. for evaluation of acute coronary syndrome, and a rapid electrocardiogram (ECG) and interpretation are imperative for initial triage. A growing number of advanced practice practitioners (APP) (e.g. physician assistants, nurse practitioners) are assisting patient care in the ED.

      Purpose

      This study aims to compare the interpretation of ECGs by experienced APPs, each having 10 or more years of experience, with resident physicians and attending physicians.

      Patients and methods

      99 ED providers were stratified into attendings, residents at varying levels, and APPs were tested to interpret 36 ECGs from a database of ECGs initially interpreted to be ST elevation myocardial infarctions, of which 24 were determined to have a culprit lesion by coronary intervention.

      Results

      Attending physicians were the most sensitive (0.86, 95% CI of 0.80 to 0.92) and specific (0.69, 95% Cl of 0.60 to 0.79) at interpreting ECGs, but APPs and physicians in their first year of practice out of residency were almost equally as sensitive [(0.82, 95% CI of 0.76 to 0.88) and (0.82, 95% CI of 0.76 to 0.88)] and specific [(0.62, 95% cl of 0.52 to 0.73) and (0.65, 95% Cl of 0.56 to 0.75)].

      Conclusion

      This study suggests the possibility of changing ED workflow where experienced APPs can be responsible for initial screening of an ECG, thus allowing fewer interruptions for ED physicians.

      Keywords

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      References

        • Levine G.N.
        • Bates E.R.
        • Blankenship J.C.
        • et al.
        2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.
        Circulation. 2016; 133: 1135-1147
        • Veronese G.
        • Germini F.
        • Ingrassia S.
        • et al.
        Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: is it enough?.
        Acute Card Care. 2016; 18: 7-10
        • McCabe J.M.
        • Armstrong E.J.
        • Ku I.
        • et al.
        Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms.
        J Am Heart Assoc. 2013; 2e000268
        • Cruz M.F.
        • Edwards J.
        • Dinh M.M.
        • Barnes E.H.
        The effect of clinical history on accuracy of electrocardiograph interpretation among doctors working in emergency departments.
        Med J Aust. 2012; 197: 161-165
        • Wagner G.S.
        • Macfarlane P.
        • Wellens H.
        • Josephson M.
        • Gorgels A.
        • Mirvis D.M.
        • et al.
        AHA/ACCF/HRS recommendations for the standardization and interpretation of the electro-cardiogram.
        J Am Coll Cardiol. 2009; 53: 1003-1011
        • Pham J.C.
        • Story J.L.
        • Hicks R.W.
        • et al.
        National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors.
        J Emerg Med. 2011; 40: 485-492
        • Westbrook J.I.
        • Woods A.
        • Rob M.I.
        • Dunsmuir W.T.M.
        • Day R.O.
        Association of interruptions with an increased risk and severity of medication administration errors.
        Arch Intern Med. 2010; 170: 683-690
        • Mawri S.
        • Michaels A.
        • Gibbs J.
        • et al.
        The comparison of physician to computer interpreted electrocardiograms on ST-elevation myocardial infarction door-to-balloon times.
        Crit Pathw Cardiol. 2016; 15: 22-25