Date of Graduation

Summer 8-9-2017

Document Type

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Mary Seed


A clinical nurse leader can develop a culture of quality in the emergency department (ED) through leading process redesign, workflow, and team engagement. The American Heart Association guidelines recommend that a 12-lead electrocardiogram (ECG) be performed and interpreted within 10 minutes of ED arrival on all patients with symptoms suggestive of ST-segment elevation myocardial infarction (STEMI). A local community hospital was not meeting this benchmark for walk-in patients presenting with chest pain or chest discomfort. Based on Lewin’s theory of change and utilizing the Institute for Healthcare Improvement’s model for improvement, a change package of practical interventions was developed and implemented to achieve improved outcomes. The primary intervention involved creating a chief complaint-based ECG guideline algorithm that streamlines the evaluation of potential cardiac patients. A secondary intervention involved designating a specific room within close proximity of the initial triage area for performing 12-lead ECGs. Methods included a microsystem assessment, literature review, team formation, rapid cycle testing, and ongoing data analysis. Results indicate a change from baseline of 64% to 88% over twelve weeks. This paper describes the process improvements and culture change required for optimizing clinical and operational outcomes in the ED.