ROUTINE ADMISSION ELECTROCARDIOGRAPHY IN EMERGENCY DEPARTMENT PATIENTS

Study objectives: To determine whether routine performance of an ECG c ould have been safely avoided in a subset of emer gency department pat ients admitted to a university hospital. Design: Retrospective consecu tive case series. Setting: University teaching hospital. Type of parti cipants: All ED patients admitted to the medical service of the study hospital during a three-month period. Methods and interventions: Accep table indications for an admission ECG were prospectively developed. C harts of all patients were reviewed to determine whether any of these indications were present, whether an admission ECG was performed, and whether an admission ECG resulted in a change in patient management or outcome. An ECG was classified as routine when performed in the absen ce of documentation of any of these indications. No interventions were performed. Measurements and main results: There were 636 ED admission s to the medical service during the study period. Of the 631 patients whose chart could be located, 384 (61%) had at least one indication fo r an ECG and all but one had an ECG performed. No indications for an a dmission ECG were identified in the remaining 247 patients; of these, 202 (82%) had an ECG per formed and 45 (18%) did not. Among the 202 wh o had a routine admission ECG, the test resulted in a change in manage ment in only three (1.5%) (95% confidence interval [Cl], 0.3% to 4.3%) and affected patient outcome in none (95% Cl, O% to 1.5%). Among the 45 without indications who did not have a routine admission ECG, none experienced an identifiable adverse consequence during hospitalization (95% Cl, O% to 6.7%). Conclusion: The admission ECG could have been a voided in an identifiable subset of ED patients admitted to the medica l service of our hospital, with no adverse effect on patient outcome. This finding, if corroborated in other patient populations, suggests t he potential for significant cost savings for the US health care syste m as a whole.