P076 - PROVINCIAL VARIABILITY AND TEMPORAL TRENDS IN TIME FROM FIRST MEDICAL CONTACT TO ECG ACQUISITION: THE MANITOBA TMT INITIATIVE

Background: Timely electrocardiogram (ECG) acquisition is essential for the early identification and treatment of acute coronary syndromes (ACS), particularly ST-elevation myocardial infarction (STEMI). Guidelines recommend ECGs be performed within 10 minutes of first medical contact (FMC) for patients with cardiac chest pain. The Ten Minute Tracing (TMT) initiative was launched by the Manitoba ACS Network to assess and improve this metric across the province. This analysis examines site-specific variability and temporal trends in FMC-to-ECG times over 29 months.

METHODS AND RESULTS: We analyzed monthly FMC-to-ECG times for adult patients presenting to seven emergency departments and urgent care centres in Manitoba between May 2022 and August 2024. One hospital was excluded from the figure due to our ongoing interventions to improve FMC-to-ECG times. Accordingly, the study included three large urban hospitals and three urgent care centres in Winnipeg, serving a population of over 700,000, and one regional hospital in Brandon, serving approximately 200,000 in western Manitoba. The urgent care centres operate with limited cardiac diagnostic capabilities but are important first-contact sites within the city. The primary metric was median FMC-to-ECG time in patients presenting with chest pain and cardiac features.
Across the seven sites, FMC-to-ECG times demonstrated marked variability. Most sites reported median times ranging from approximately 24 to 30 minutes, while one site consistently exceeded 30 minutes. Only one site approached the 10-minute target, with sustained median times in the 13–14 minute range. No site demonstrated sustained improvement over the observation period. These findings are summarized in Figure 1, which illustrates the persistent site-specific variation and the absence of consistent temporal trends.

Conclusion: Despite recognition of the importance of early ECG acquisition, FMC-to-ECG times remain above recommended targets across Manitoba hospitals. Site-specific variability and lack of consistent improvement suggest that passive awareness is insufficient. These findings informed the design of the TMT campaign, emphasizing the need for structured, site-level quality improvement to achieve meaningful change in ACS care.