Improving the Acquisition, Interpretation, and Documentation of Electrocardiograms (ECGs) in Patients Suspected of Having Acute Coronary Syndrome: A Clinical Audit Conducted in Emergency Departments Across Sudan

Abstract

BACKGROUND: Early electrocardiogram (ECG) acquisition, interpretation, and documentation are critical in the management of patients with chest pain. The American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend that an ECG should be obtained and interpreted within 10 minutes of arrival in the emergency department (ED) for any case of acute coronary syndrome (ACS). This study aimed to assess and improve adherence to these guidelines in the Sudanese ED. METHODS: A clinical audit was conducted in two cycles at Kassala Teaching Hospital in Sudan. The first cycle evaluated baseline adherence to ECG acquisition, interpretation, and documentation times. Interventions, including educational sessions and posters, were implemented to address gaps. The second cycle assessed the impact of these interventions. Data were collected using a standardized checklist and analyzed using the Statistical Package for the Social Sciences software, version 25 (IBM Corp., Armonk, NY). RESULTS: In the first cycle (n = 25), the average time from arrival to ECG acquisition was 29.84 minutes, with only 4% of patients having documentation completed within 10 minutes. After intervention, the second cycle (n = 22) showed significant improvement, with 81.8% of patients achieving the 10-minute target. Documentation quality also improved, with "Rhythm," "Rate," and "ST segment" being the most frequently documented elements. CONCLUSION: Targeted interventions have significantly improved adherence to AHA/ACC guidelines for ECG acquisition, interpretation, and documentation in Sudanese EDs. These findings highlight the importance of continuous education and monitoring to enhance the quality of care for patients with suspected ACS.