Background: Pediatric ECGs and ECG interpretation were all paper-based until 2012 at our Children’s Hospital. There were significant delay between the time when the ECGs were performed and when they were officially interpreted by a cardiologist for the formal the medical records. To better understand the factors contributing to the delay or failure to complete an ECG report, we created a Fishbone (Ishikawa) Diagram to help facilitate a solution. (See Diagram 1 below). We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted and improve the capture and billing of ECG services.
Diagram 1-Fishbone diagram of factors affecting ECG flow
Methods: As part of a hospital wide quality improvement initiative, a digital ECG service (Muse®, GE) was implemented at the Children’s Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era (Post-Digital, June 2012 - Dec 2012) was compared to 18 months of the pre-digital era (Pre-Digital, Jan 2011 - May 2012). In addition, billing times were compared in the Pre-Digital and Post-Digital eras and an assessment of workflow were performed. Pre-Digital and Post-Digital data were compared via t-tests. (Diagram 2 illustrates the ECG workflow in both eras)
Diagram 2-ECG workflow in the Pre Digital vrs Digital Eras
Conclusion: Implementation of a digital ECG system increased the volume of ECGs interpreted and reported at a children’s Hospital.