P057 - ACHIEVING AND SUSTAINING ECG ACQUISITION WITHIN TEN MINUTES OF FIRST MEDICAL CONTACT: RESULTS FROM A COMMUNITY HOSPITAL IN WINNIPEG

Background: Timely electrocardiogram (ECG) acquisition is a cornerstone of acute coronary syndrome (ACS) care. Canadian guidelines recommend ECG completion within 10 minutes of first medical contact (FMC) for patients presenting with suspected cardiac symptoms. The Ten Minute Tracing (TMT) campaign, initiated by the Manitoba ACS Network, aimed to improve this metric across the province. We chose a mid-sized urban hospital in the western part of Winnipeg, serving a diverse community and offering 24/7 emergency services and inpatient care of stable cardiac patients, but without on-site PCI.

METHODS AND RESULTS: Adult patients presenting with chest pain with cardiac features to our study hospital Emergency Department were tracked from May 2022 to August 2024. At baseline (Month 1), the median FMC-to-ECG time was 31.5 minutes. Process changes in subsequent months included staff education, technician responsiveness protocols, and a critical intervention empowering registration clerks to identify patients and initiate ECG calls directly.
During the partial improvement phase (Months 2–13), efforts focused on developing a process to promptly identify patients requiring an ECG and establishing infrastructure in the ED to support ECG acquisition at triage. Median FMC-to-ECG times fell to approximately 15 minutes. In the sustained improvement phase (Months 14–29), further reductions were achieved through protocols empowering non-medical staff to initiate ECGs for patients with symptoms concerning for ACS, coupled with ongoing interdisciplinary education and communication. Median times consistently remained below the 10-minute target. These gains were achieved without additional staffing or increases in ECG volume—for example, 528 ECGs were performed in March 2024, comparable to previous months.

Conclusion: Our study hospital’s experience demonstrates that sustained improvements in FMC-to-ECG times can be achieved through targeted, low-cost process redesign. Empowering frontline registration staff played a pivotal role in reaching the 10-minute target. Stable ECG volumes and reliance on existing personnel emphasize the efficiency of the intervention. This approach provides a scalable, resource-conscious model for enhancing ACS care in emergency settings.