title: Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study.
abstract: BACKGROUND
  The impact of misinterpretation of the ECG in patients with acute myocardial infarction (AMI) in the emergency department (ED) setting is not well known. Our goal was to assess the prevalence of the failure to identify high-risk ECG findings in ED patients with AMI and to determine whether this failure is associated with lower-quality care.
  
  
  RESULTS
  In a retrospective cohort study of consecutive patients presenting to 5 EDs in California and Colorado from July 1, 2000, through June 30, 2002, with confirmed AMI (n=1684), we determined the frequency of the failure by the treating provider to identify significant ST-segment depressions, ST-segment elevations, or T-wave inversions on the presenting ECG. In multivariable models, we assessed the relationship between missed high-risk ECG findings and evidence-based therapy in the ED after adjustment for patient characteristics and site of care. High-risk ECG findings were not documented in 201 patients (12%). The failure to identify high-risk findings was independently associated with a higher odds of not receiving treatment among ideal candidates for aspirin (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.51 to 2.94), beta-blockers (OR, 1.85; 95% CI, 1.14 to 3.03), and reperfusion therapy (OR, 7.69; 95% CI, 3.57 to 16.67). Among patients with missed high-risk ECG findings, in-hospital mortality was 7.9% compared with 4.9% among those without missed findings (P=0.1).
  
  
  CONCLUSIONS
  The failure to identify high-risk ECG findings in patients with AMI results in lower-quality care in the ED. Systematic processes to improve ECG interpretation may have important implications for patient treatment and outcomes.
authors.affiliation: Department of Medicine, Denver Health Medical Center, 777 Bannock St, Denver, CO 80204, USA. fred.masoudi@uchsc.edu
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Tricomi
authors.forename: Ella E
authors.initials: EE
authors.lastname: Lyons
authors.forename: Laurie
authors.initials: L
authors.lastname: Crounse
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002140:California; D015331:Cohort Studies; D003120:Colorado; D003951:Diagnostic Errors; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D011787:Quality of Health Care; D015424:Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D001241:Aspirin