Khan Muhammad Ishaq, Mujtaba Muhammad, Waheed Nazia
Muhammad Ishaq Khan, Fellow interventional cardiology, Peshawar Institute of Cardiology, Peshawar, Pakistan.
Abidullah, Head of Department Cardiology Unit, Peshawar Institute of Cardiology, Peshawar, Pakistan.
Pak J Med Sci. 2025 Jul;41(7):2160-2163. doi: 10.12669/pjms.41.7.11635.
BACKGROUND & OBJECTIVE: Acute myocardial infarction is the leading cause of heart disease worldwide. Timely diagnosis and decision of management plan is paramount which is pinned on early electrocardiogram to minimize the door-to-electrocardiogram time. Our objective was to evaluate the current practice of timing of initial electrocardiogram of patients presenting with Acute myocardial infarction at our local cardiac hospital in Pakistan and implement changes with a complete closed loop audit.
Retrospective and prospective data collection for all patients who presented to the emergency room of Peshawar Institute of Cardiology from September 2022 till September 2023. The hospital management information system and electronic medical record of the hospital was used for data collection.
A total of 149 patients' data was collected and analyzed. The first cycle of the audit analyzed 29 patients, the second cycle of the audit analyzed 60 patients and the third cycle of the audit again analyzed 60 patients. In the first set of patients, 17.2 percent of patients had door-to-ECG time of less than 10 minutes which was far from ideal. Therefore different departmental meetings were conducted and it was decided to set up a designated triage for ACS patients. Therefore in the second cycle of the audit 43.3% of patients achieved this time showing improvement. During the third cycle when the initial registration and formal paperwork for admission to ER were removed then 75% of patients had their ECG done within 10 minutes of the presentation.
This audit successfully identified the modifiable factors responsible for the delay in the first ECG which included a lack of staff, non-viability of triage, and paperwork. After working on these factors our target Door to ECG time of 75% was achieved.
急性心肌梗死是全球范围内心脏病的主要病因。及时诊断并确定治疗方案至关重要，这依赖于早期心电图检查以尽量缩短从入院到心电图检查的时间。我们的目的是评估巴基斯坦当地一家心脏病医院中急性心肌梗死患者首次心电图检查时间的当前情况，并通过完整的闭环审核来实施改进措施。
对2022年9月至2023年9月期间在白沙瓦心脏病学研究所急诊室就诊的所有患者进行回顾性和前瞻性数据收集。使用医院管理信息系统和医院电子病历进行数据收集。
共收集并分析了149例患者的数据。审核的第一个周期分析了29例患者，第二个周期分析了60例患者，第三个周期再次分析了60例患者。在第一组患者中，17.2%的患者从入院到心电图检查的时间少于10分钟，这远不理想。因此召开了不同部门的会议，并决定为急性冠状动脉综合征患者设立专门的分诊流程。因此在审核的第二个周期中，43.3%的患者达到了这一目标时间，显示出了改善。在第三个周期中，当去除了急诊室入院的初始登记和正式文书工作后，75%的患者在就诊后10分钟内完成了心电图检查。
本次审核成功识别出导致首次心电图检查延迟的可改变因素，包括人员不足、分诊流程不可行以及文书工作。针对这些因素采取措施后，我们实现了75%的从入院到心电图检查的目标时间。
