A quality improvement project to reduce door-to-electrocardiogram time: A multicenter study.

OBJECTIVE: To improve compliance with a target door-to-electrocardiogram (EKG) time of 10 minutes or less in patients presenting with symptoms concerning for acute coronary syndrome. METHODS: A pre-post study was performed between January 2014 and May 2016 at five emergency departments (EDs) in Saudi Arabia. Patients who presented to ED with symptoms concerning for acute coronary syndrome were included in the study. The primary outcome of interest was whether EKG was completed within 10 minutes after the patient arrival to ED. Quality improvement interventions consisted of human resources adjustments, education, technological improvements, and improved interdepartmental collaboration. Multivariate analysis was used to model the percentage of EKGs that were completed within the targeted time. RESULTS: During the study period, 11,518 patients received EKGs. Prior to the intervention, compliance with a door-to-EKG time of 10 minutes or less was found to be 62.6%. Post intervention, compliance improved to 87.7%. On multivariate analysis, male patients were significantly more likely to receive EKG within 10 minutes than female patients (odds ratio = 1.231, 95% confidence interval = 1.113-1.361; p < 0.001). CONCLUSION: A quality improvement project can successfully increase the percentage of patients receiving EKG within 10 minutes of presentation to ED. Further research is required to demonstrate the clinical significance of improved door-to-EKG times.

A multi-faceted approach of a nursing led education in response to MERS-CoV infection.

BACKGROUND: The emergence of the Middle East respiratory syndrome-coronavirus (MERS-CoV) resulted in multiple healthcare associated outbreaks. In response, we developed a nurse-led program to screen and triage patients with MERS-CoV infection. METHODS: A formal educational program was implemented to ensure a standardized approach to care planning and delivery. The essential skills that were included were the use of Personal Protective Equipment (PPE) including gown, gloves, head cover and N95 mask, hand hygiene, the practice of donning and doffing and the collection of MERS-CoV nasopharyngeal specimens. RESULTS: A core group of nurses were identified from high-risk units. The education program consisted of four skill-days. Nurses were assigned a pre-course work from Mosby's Nursing Skills, an online skill module, donning and doffing of PPE, and the process for obtaining a nasopharyngeal swab. The skill lab incorporated multiple methods such group discussion, watching an on-line video, and a simulated demonstration and practice on a mannequin. In total, 450 nurses attended the Nasopharyngeal Skills Day and 1000 nurses received training. Donning and doffing PPE and N95 mask fit testing has become an annual mandatory competency requirement for staff in nursing and clinical services. CONCLUSION: The application of specified protocols minimizes the risks of cross infection, placing emphasis on patient and staff safety as well as expediting the patient to definitive treatment. Nurse educators have an instrumental role in training nurses and other healthcare providers on the specifics needed to identify, contain and manage patient presenting with MERS-CoV.