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Better care for cardiac patients


“We know there is still work to do, but we’ve made significant headway. There are fewer ‘redos,’ staff are working more efficiently, there is less waste and patients are receiving better quality, safer care.” Vicki Ehrlich Director, Cardio-Neuro Diagnostic Services

Jocelyn de Hoop, a cardiology technologist, demonstrates proper ECG labelling.

When you’re having a heart attack, there’s no time to waste.

“The sooner you do the diagnostics, the less damage to the heart,” said Vicki Ehrlich, director, Cardio Services program. “Permanent damage to the heart will keep happening until the patient gets the treatment they need.”

One reason cardiac patients experience care delays seems to be a simple one – staff improperly label electrocardiogram (ECG) tests. ECG and blood test results are necessary to diagnose and begin treatment for a heart attack. If labelling is imprecise, and staff can’t be certain who the test belongs to, the ECG is unusable. The patient will need to have the test redone, causing a delay in care.

Ehrlich knew incorrect labelling was an issue but it wasn’t until she and the other members of her mistake proofing team did an audit in December 2015 that she learned the extent of the matter.

Of 2,371 ECG tests the team examined, 423 lacked key labelling information. Errors include failure to include the patient’s full name, age, medical record number, date of birth, gender, and name and designation of the staff member obtaining the test. That’s nearly an 18 per cent defect rate. This means that, potentially, the care of 18 per cent of patients was delayed because of labelling errors.

“December is not a typical month,” said Ehrlich, recalling the findings. “On average we do between 4,000 and 5,000 ECGs between Pasqua Hospital (PH) and Regina General Hospital (RGH) a month. Further audits showed our error rates ranged between 17 and 33 per cent. During one evening audit, we found all 24 ECGs performed were improperly labelled. It became clear that we had a large problem.”

This concern, along with the knowledge that Enovation – the system used to create the labels – would soon be terminated, spurred Ehrlich and her team to improve the ECG labelling process.

Ehrlich and her team observed that cardiology technologists, whose core responsibilities include performing ECG tests, typically had no labelling defects. The technologists work from 7 a.m. to 11 p.m. daily. For the remaining eight hours, registered nurses at PH and RGH fulfil this role. Ehrlich noticed the nurses were inconsistent in their ECG labelling practices and expects the variance is most likely related to differences in how nurses are taught to obtain ECGs.

To ensure that all those who provide the tests follow the same processes, the project team created work standards and expectations around proper ECG labelling; circulated information on the two-patient identifier policy and put stickers on ECG machines to remind staff about appropriate labelling,

To assist staff in tracking where errors originate, the team numbered ECG carts at both PH and RGH according to site and department.

A cardio-neuro educator, who is a cardiology technologist, now leads the training of all new staff. The team created a step-by-step video for staff to observe the labelling process.

The improvements have resulted in big change.

“At our 90-day audit, our defect rate was 5.6 per cent,” said Ehrlich. “While there is still more work to do, this is significant.’”