# Improving Door-to-ECG Time in Acute Myocardial Infarction: A Closed-Loop Audit from a Tertiary Care Center in Peshawar

## TL;DR

This study improved door-to-ECG time for heart attack patients in a Pakistani hospital through a closed-loop audit and process changes.

## Contribution

A closed-loop audit system was implemented to reduce door-to-ECG time in acute myocardial infarction patients.

## Key findings

- Initially, only 17.2% of patients had door-to-ECG time under 10 minutes.
- After process changes, 75% of patients achieved door-to-ECG time under 10 minutes.
- Key delays were due to staffing, triage inefficiency, and paperwork.

## Abstract

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.