Door-to-ECG Time in Patients Presenting with Chest Pain to the Emergency Department: A Clinical Audit from a Tertiary Care Hospital.

Abstract

Background: Chest pain is one of the most common and potentially life-threatening presentations in emergency departments worldwide. Rapid electrocardiographic (ECG) evaluation is critical for the early identification of acute coronary syndrome (ACS), including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). International guidelines recommend that a 12-lead ECG should be obtained and interpreted within 10 minutes of first medical contact to ensure timely diagnosis and management. Delays in ECG acquisition may lead to delayed diagnosis, delayed initiation of treatment, and poorer patient outcomes. This clinical audit aimed to assess adherence to international recommendations regarding door-to-ECG time in patients presenting with chest pain to the emergency department of a tertiary care hospital.

Methodology: A retrospective clinical audit was conducted in the Emergency Department of Lady Reading Hospital, Peshawar, during August 2025. A total of 250 adult patients presenting with non-traumatic chest pain suggestive of ACS were included. Data were collected from emergency department triage logs, ECG machine timestamps, and clinical records. The primary outcome measured was the time from patient arrival to ECG acquisition (door-to-ECG time). Compliance with the recommended standard of ECG acquisition within 10 minutes was evaluated using descriptive statistical analysis.

Results: Among the 250 patients analyzed, the mean door-to-ECG time was 12.9 minutes. A total of 134 patients (53.6%) received an ECG within the recommended 10-minute timeframe, while 116 patients (46.4%) experienced delays exceeding 10 minutes. The most frequently documented reason for delay was overcrowding in the initial assessment area, particularly during peak patient flow periods.

Conclusion: This clinical audit demonstrates suboptimal adherence to international door-to-ECG time standards in patients presenting with chest pain. System-level factors, particularly emergency department overcrowding and workflow congestion, appear to contribute significantly to these delays. Implementing targeted interventions such as chest pain fast-track protocols, ECG acquisition at triage, and improved staff training may enhance compliance with recommended timelines and improve the quality of emergency cardiac care.