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Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative

Introduction Unnecessary “admission electrocardiograms (EKGs)” on admitted patients waiting (“boarding”) in the emergency department (ED) are often ordered. We introduced evidence-based EKG ordering guidelines and determined changes in the percent of patients with "preadmission" and "...

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Autores principales: Appold, Brendan, Soniega-Sherwood, Jennie, Persaud, Riaad, Moss, Rachel, Ramnarine, Mityanand, LaVine, Sean P, Bhansali, Rohan, Ahn, Seungjun, Richman, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552818/
https://www.ncbi.nlm.nih.gov/pubmed/34722095
http://dx.doi.org/10.7759/cureus.18351
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author Appold, Brendan
Soniega-Sherwood, Jennie
Persaud, Riaad
Moss, Rachel
Ramnarine, Mityanand
LaVine, Sean P
Bhansali, Rohan
Ahn, Seungjun
Richman, Mark
author_facet Appold, Brendan
Soniega-Sherwood, Jennie
Persaud, Riaad
Moss, Rachel
Ramnarine, Mityanand
LaVine, Sean P
Bhansali, Rohan
Ahn, Seungjun
Richman, Mark
author_sort Appold, Brendan
collection PubMed
description Introduction Unnecessary “admission electrocardiograms (EKGs)” on admitted patients waiting (“boarding”) in the emergency department (ED) are often ordered. We introduced evidence-based EKG ordering guidelines and determined changes in the percent of patients with "preadmission" and "admission" EKGs ordered before vs. after guideline introduction and which patient characteristics predicted EKG ordering. Methods In 2016, our ED, cardiology, and hospitalist services implemented EKG ordering guidelines to reduce unnecessary ED EKGs ordered after disposition. We compared pre- vs. post-guideline EKG ordering to determine whether guidelines were associated with changes in "preadmission" or "admission EKG" ordering. Patients with an admission diagnosis unrelated to cardiac or pulmonary systems were included. An EKG was “admission” if the order time was after disposition time. The numerator was the number of "admission EKGs" ordered; the denominator was the total number of such admissions; those with "preadmission EKGs" were excluded from this analysis. Variables that might influence EKG ordering were explored. The chi-square test with Bonferroni adjustment was used to compare 2015 vs. 2016 percentages of patients with an “admission EKG.” Results There was a decrease in unwarranted "admission EKGs" among ED boarding patients (44.1% pre-implementation to 27.5% by two years post-implementation) and an increase in unwarranted "preadmission EKGs" (66.1% pre-implementation to 72.8% post-implementation). Age ≥40 and past medical history independently predicted EKG ordering. Discussion The decrease in the ordering of "admission EKGs" but "preadmission EKGs" suggests the decline reflects a true change in ordering and not a general environmental/ecologic decline in ordering. This highlights the importance of careful guideline development and implementation.
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spelling pubmed-85528182021-10-28 Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative Appold, Brendan Soniega-Sherwood, Jennie Persaud, Riaad Moss, Rachel Ramnarine, Mityanand LaVine, Sean P Bhansali, Rohan Ahn, Seungjun Richman, Mark Cureus Cardiology Introduction Unnecessary “admission electrocardiograms (EKGs)” on admitted patients waiting (“boarding”) in the emergency department (ED) are often ordered. We introduced evidence-based EKG ordering guidelines and determined changes in the percent of patients with "preadmission" and "admission" EKGs ordered before vs. after guideline introduction and which patient characteristics predicted EKG ordering. Methods In 2016, our ED, cardiology, and hospitalist services implemented EKG ordering guidelines to reduce unnecessary ED EKGs ordered after disposition. We compared pre- vs. post-guideline EKG ordering to determine whether guidelines were associated with changes in "preadmission" or "admission EKG" ordering. Patients with an admission diagnosis unrelated to cardiac or pulmonary systems were included. An EKG was “admission” if the order time was after disposition time. The numerator was the number of "admission EKGs" ordered; the denominator was the total number of such admissions; those with "preadmission EKGs" were excluded from this analysis. Variables that might influence EKG ordering were explored. The chi-square test with Bonferroni adjustment was used to compare 2015 vs. 2016 percentages of patients with an “admission EKG.” Results There was a decrease in unwarranted "admission EKGs" among ED boarding patients (44.1% pre-implementation to 27.5% by two years post-implementation) and an increase in unwarranted "preadmission EKGs" (66.1% pre-implementation to 72.8% post-implementation). Age ≥40 and past medical history independently predicted EKG ordering. Discussion The decrease in the ordering of "admission EKGs" but "preadmission EKGs" suggests the decline reflects a true change in ordering and not a general environmental/ecologic decline in ordering. This highlights the importance of careful guideline development and implementation. Cureus 2021-09-28 /pmc/articles/PMC8552818/ /pubmed/34722095 http://dx.doi.org/10.7759/cureus.18351 Text en Copyright © 2021, Appold et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Appold, Brendan
Soniega-Sherwood, Jennie
Persaud, Riaad
Moss, Rachel
Ramnarine, Mityanand
LaVine, Sean P
Bhansali, Rohan
Ahn, Seungjun
Richman, Mark
Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title_full Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title_fullStr Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title_full_unstemmed Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title_short Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative
title_sort reining in unnecessary admission ekgs: a successful interdepartmental high-value care initiative
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552818/
https://www.ncbi.nlm.nih.gov/pubmed/34722095
http://dx.doi.org/10.7759/cureus.18351
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