Abstract 380: S.T.A.T. ECGs: Supporting Technicians in Acquiring Timely ECGs

Introduction/Background: A quality improvement project at the University of Colorado Hospital (UCH) was initiated to better understand perceived delays in the completion of STAT priority electrocardiograms (ECGs). The project team obtained ECG acquisition time data from the electronic health record in order to describe delays and evaluate potential solutions. Methods: Analysis of 25,159 completed, time-stamped inpatient ECGs completed at UCH between 1/1/2018 and 10/30/2018 were completed. Descriptive statistics for ECG volume, ECG completion delays and total AHT staffing levels were calculated and correlations between ECG characteristics and delays were examined. Between February and April 2019, a trained qualitative researcher completed interviews and observations with UCH staff involved in ECG completion, focusing on work processes and the workplace environment. Based on these initial quantitative and qualitative analyses, a simulation model was developed to evaluate changes in 1) technician shifts and staffing ratios; 2) the proportion of STAT orders; and 3) nurse training to help perform ECGs. Results: ECGs were ordered with a STAT priority in 40% of cases and, among individual providers, use of the STAT priority varied from 7% to 95%. ECG completion was delayed (>15 minutes) for 35% of STAT ECGs, compared to less than 10% of non-stat ECGs. In qualitative interviews, technicians described a “cascade” effect to delays resulting from a compounding effect of a series of late ECGs and supported by the quantitative observation that delays are strongly correlated with STAT ECG volume. Technicians also described spikes in ECG ordering during hours in which staffing levels are low and for non-emergency reasons (such as discharge), a finding again supported by quantitative analysis. Results of discrete event simulation suggest: adding technician staffing hours during the day outperforms reducing the proportion of STAT ECGs; short shifts (4-8 hours) may be a cost effective way to add personnel; ECG training for Cardiology nurses, who expressed a desire to help with ECG completion, could additionally offload technicians and reduce delays; the negative effect of technician “attrition” - e.g. a technician calls in sick and is not replaced - is more powerful than the positive effect of any intervention. That technicians described a hectic and unforgiving work environment suggests workplace interventions to manage the volume of ECGs per technician may improve satisfaction and avoid technician attrition. Conclusions: In light of the above findings, UCH operations leadership trained charge nurses on Cardiology units to perform STAT ECGs and are evaluating processes by which technician breaks are more structured, a feedback process is more formalized and staffing hours are more reflective of hourly fluctuations in ECG volume. Results of these interventions will be the subject of future analyses.