IMPROVING ECG DIAGNOSTIC ACCURACY IN EMERGENCY MEDICAL SERVICES PERSONNEL

Abstract

Accuracy of ECG interpretation is important for identification of ST-elevation myocardial infarctions (STEMI) by Emergency Medical Service (EMS) personnel who recognize STEMIs in the field and activate the coronary catheterization lab (CCL). Based on our previous research there is improvement in diagnostic accuracy of STEMIs for healthcare providers that read an average of >20 ECGs per week. This study evaluated the effectiveness of online ECG education modules on improving ECG diagnostic accuracy. EMS personnel received 25 ECGs per week to interpret via an online program. Evaluation for effect on improvement in diagnostic accuracy was assessed via completion of an ECG evaluation package before and after the intervention. Data was collected regarding job satisfaction to determine if the educational initiative had any significant impacts. A total of 64 participants completed the education modules and accompanying evaluation packages. Overall, there was a significant improvement in ECG diagnostic accuracy from 51 to 62% (95% CI 7.7-13.2, p < 0.0001). Specifically there was statistically significant improvement in the diagnosis of STEMI (8.5% (95% CI 4.9-12.3), p < 0.003) and supraventricular tachycardia (39% (95% CI 17.2-60.8, p < 0.008), with the trend toward improvement in all other diagnoses. These effects were sustained out to the three-month follow up period (9.6% (95% CI 6.4-12.7), p= < 0.0001). Improvement was seen regardless of EMS personnel’s employment experience and training. There was no significant impact on job satisfaction. ECG exposure remains an important factor in improving the accuracy of ECG diagnosis in EMS personnel. Online education modules provide an easily accessible way of improving ECG interpretation with the opportunity for positive downstream effects on patient outcomes and resource utilization.