481 Door to ECG Times in Rural NSW Hospitals

Abstract

Door to ECG time is a well-established metric for ensuring rapid identification and treatment of Acute Coronary Syndromes (STEMI and NSTEMI) with direct implications for morbidity and mortality. Advances in technology have improved ECG acquisition including Ambulance pre hospital assessment, however Rural and remote patients remain potentially disadvantaged due to reduced access to immediate care related to distance and resource limitations. This review aimed to establish if evidence of clinical variation exists in meeting the National standard 10 minute Door to ECG times in Rural Hospitals within NSW to warrant further assessment. A total of 473 patients presenting with ACS symptoms were retrospectively reviewed from a random sample of patients from 26 Rural Emergency Departments over a 12 month period. Door to ECG times were measured from the patient management system arrival and ECG time stamp. The data analysed included facility, age, gender, and Indigenous status. Prehospital ECGs were excluded. 55% of patients were male, mean age 59, and 12% identified as Aboriginal. Door to ECG times ranged from 0 to 145 minutes. The mean Door to ECG time was 17 minutes, with a median time of 13 minutes (IQR 8-21). 40% (n=189) of all patients had a door to ECG time of less than 10 minutes. Variation in standard of care existed (ECG within 10 minutes) in over half of the sample. Further exploration of factors influencing ECG times is warranted given these results.