Date of Graduation
Restricted Project/Capstone - USF access only
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
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.
Estabillo, Arbie, "The Clinical Nurse Leader as Outcomes Manager in the Emergency Department: Improving Door-to-ECG Time for Patients Presenting with Chest Pain" (2017). Master's Projects and Capstones. 596.
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