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Safety of Computer Interpretation of Normal Triage Electrocardiograms
Author(s) -
Hughes Katie E.,
Lewis Scott M.,
Katz Laurence,
Jones Jonathan
Publication year - 2017
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13067
Subject(s) - triage , medicine , emergency department , clinical significance , emergency medicine , confidence interval , medical emergency , cardiology , nursing
Objectives Frequent interruptions within the emergency department may lead to errors that negatively impact patient care. The immediate review of electrocardiograms ( ECG s) obtained from triage patients is one source of interruption. Limiting triage ECG s requiring immediate attending review to those interpreted by the computer as abnormal may be one way to reduce interruption. We hypothesize that triage ECG s interpreted by the computer as “normal ECG ” are unlikely to have clinical significance that would affect triage care. Methods All triage ECG s performed at the University of North Carolina were collected between November 14, 2014, and March 3, 2015, according to a standard nursing triage protocol using GE machines running Marquette 12 SL software. Triage ECG s with a computer interpretation of “normal ECG ” were compared to an attending cardiologist's final interpretation. Triage ECG s for which the cardiologist's interpretation differed from the computer interpretation of normal ECG were presented to two emergency physicians ( EP s) blinded to the goals of the study. The physicians were asked to evaluate the ECG for clinical significance. Clinical significance was defined as any change from normal that would alter triage care. Triage ECG s were considered true negatives if either the cardiologist agreed with the normal computer interpretation or if both EP s agreed that the ECG did not show clinical significance. Results A total of 855 triage ECG s were collected over 16 weeks. A total of 222 (26%) were interpreted by the computer as normal. The negative predictive value for a triage ECG s interpreted by the computer as “normal” was calculated to be 99% (95% confidence interval = 97% to 99%). Of the ECG s with a computer interpretation of normal ECG , 13 had an interpretation by an attending cardiologist other than normal. Two attending EP s reviewed these triage ECG s. One of the 13 ECG s was found to have clinical significance that would alter triage care by one of the EP s. The stated triage intervention was “bed immediately.” Conclusions Our data suggest that triage ECG s identified by the computer as normal are unlikely to have clinical significance that would change triage care. Eliminating physician review of triage ECG s with a computer interpretation of normal may be a safe way to improve patient care by decreasing physician interruptions.