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Goenka, A., Mundkur, S., Sujir Nayak, S., Shetty, A., Thomas, J., Mymbilly Balakrishnan, J., et al. (2024) Improving the Emergency Services Using Quality Improvement Project and Donabedian Model in a Quaternary Teaching Hospital in South India. BMJ Open Quality, 13, e002246.
https://doi.org/10.1136/bmjoq-2022-002246

has been cited by the following article:

• TITLE: Implementing an Electrocardiogram Suite in the Emergency Department to Decrease Door-to-EKG Time

  AUTHORS: Kimberly Evette Ortuno

  KEYWORDS: Triage, Critical Clinical Workflow Process, Chest Pain, Electrocardiogram (EKG), Door-to-EKG (DTE) Time

  JOURNAL NAME: Open Journal of Nursing, Vol.16 No.1, January 19, 2026

  ABSTRACT: Ineffective emergency department (ED) triage results in preventable medical errors, like untimely electrocardiogram (EKG) completion for patients with chest pain (CP), that increase the risk of patient harm. Obtaining EKGs within 10 minutes of ED arrival is standard of practice because CP is a classic symptom associated with myocardial infarctions (MIs) commonly called heart attacks. Early identification of ST-elevation myocardial infarction on EKG can reduce mortality rates for these patients. The project site’s 2025 second quarter mean door-to-EKG (DTE) time was 18.27 minutes. The purpose of this quality improvement project was to implement interventions to partially redesign and improve the triage process to assist ED staff at the project site in meeting the 10-minute practice standard. The direct practice quality improvement project was completed in partial fulfillment of the requirements for the Doctor of Nursing Practice degree. The project had a quantitative quasi-experimental methodology and was guided by Donabedian’s Framework and Lewin’s Change Theory. Staff participants received pre-intervention education on the Emergency Severity Index (ESI) followed by eight weeks of implementing the ESI and a dedicated EKG suite. The site’s daily census fluctuated between 80-115 patients with productivity levels permitting 26 employees scheduled in 24 hours. Pre- and post-intervention mean DTE time was evaluated for the unpaired samples of walk-in patients reporting CP via retrospective chart review. A one-tailed Welch’s t-test was used for statistical analysis. Post-intervention results (M = 9.84, SD = 4.82) compared to pre-intervention results (M = 18.53, SD = 17.53) showed statistical significance with t(55.23) = 3.35, p d = 0.68. Organizations should mandate training on valid triage tools and the establishment of EKG suites to reduce DTE time. Decreasing DTE time can reduce the cost burden on healthcare systems associated with the length of hospital stay. Hospitals can also expect financial gain through cost-avoidance by implementing cost-effective practices and process changes.