For patients in the throes of a serious heart attack, every minute in the emergency room isn’t just serious: it’s life or death.
Each second it takes a nurse or doctor to diagnose the heart attack using an electrocardiogram (EKG), the blocked heart muscle rapidly loses oxygen and begins to die. This is especially true in cases of a deadly type of attack known as an ST Elevation Myocardial Infarction (STEMI).
“If a STEMI is not recognized immediately, that muscle is lost,” said Bernadette Springer, MS, FNP-BC, RN, Nurse Manager at Mount Sinai Queens. “In the worst possible outcome, that patient may die.”
These serious consequences rang alarm bells for Springer. She discovered that, in 2019, only 26 percent of patients at her hospital who were transferred from the ER to the cardiac catheterization lab had undergone an EKG within the recommended 10 minutes upon arrival. The American Heart Association has found that performing an EKG on patients who complain of chest pain within 10 minutes is “critical to achieving the best outcomes.”
Bernadette Springer, MS, FNP-BC, RN spearheaded the EKG compliance project.
Then a fellow with United Hospital Fund and Greater New York Hospital Association’s Clinical Quality Fellowship Program (CQFP), Springer decided to make it her mission to ensure that rapid EKGs in the ER became standard practice.
Adopting this challenge as her CQFP project, Springer soon discovered that the delay in getting patients a timely EKG was largely because nurses working at the triage station had to wait for a medical technician to come and perform the test. When those technicians were not immediately available, patients would be moved from the triage station to a bed, to be followed up with later.
Given those circumstances, Springer determined that the solution was clear.
“We decided to train our triage nurses to conduct any EKG,” said Springer. “Then, when the med techs aren’t available, the nurses can jump in.”
Within three months, the compliance rate for EKG timing at Mount Sinai Queens not only improved—it became flawless. By April 2020, 100 percent of patients eventually transferred to the hospital’s cardiac catheterization lab received an EKG within 10 minutes of arrival.
According to Springer, most patients actually received an EKG within the first one or two minutes of their arrival in the emergency room, with the EKG being completed simultaneously with triage.
“That was a really big deal,” said Springer. “It was amazing.”
Two members of Bernadette Springer's team present the EKG project at the Institute for Healthcare Improvement forum.
The improvement not only means that an acute heart attack is recognized more quickly, but that patients are treated sooner and moved more efficiently through the ER, she added.
This success has expanded to other hospitals in the years since Springer’s project, which was completed in 2020 and early 2021.
Since then, according to surveys conducted three times a year, Mount Sinai Queens has maintained its 100-percent compliance rate, and even expanded the project’s workflow to The Mount Sinai Hospital, located in Manhattan. Springer’s project was featured at Mount Sinai Research Day and, most recently, at the Institute for Healthcare Improvement forum.
The team also noticed that the benefits of new nurse training—adopted for all new Mount Sinai Queens ER hires—have surpassed diagnosing heart attacks in the emergency room.
“For patients who have a sudden change in condition, nurses can now readily perform an EKG at the bedside,” said Springer, noting that this is especially important during potential staff shortages. “That helps us all.”
Springer credits the team model taught by the Clinical Quality Fellowship Program for playing a significant role in helping her complete her project. The program trains mid-career physicians, nurses, and physician assistants to become quality improvement and patient safety leaders within their organizations.
“CQFP taught us a group approach, not just putting ideas out there, but getting people’s input from across the board,” she said.
The 15-month fellowship program operates in partnership with the Greater New York Hospital Association (GNYHA). It has trained 260 participants from more than 50 health care facilities in the New York metropolitan area since it started in 2009.