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.
","abstract_html":"<p>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.</p>","abstract_has_math":false,"creators":["Estabillo, Arbie"],"institution":null,"degree_name":"Master of Science in Nursing (MSN)","degree_level":"Restricted Project/Capstone - USF access only","degree_discipline":null,"degree_department":null,"school":null,"contributors":["Dr. Mary Seed"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2017,"date_issued":"2017-08-09T07:00:00Z","date_published":"2017-08-09T07:00:00Z","updated_at":"2026-07-24T05:44:00Z","subjects":["clinical nurse leader","emergency department","quality improvement","door-to-ECG","STEMI","outcomes","Critical Care Nursing","Medicine and Health Sciences","Nursing"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://repository.usfca.edu/capstone/596","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Dr. Mary Seed"]},{"key":"dc:creator","label":"Author","values":["Estabillo, Arbie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2017-08-07T07:00:00Z"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Restricted Project/Capstone - USF access only"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Master of Science in Nursing (MSN)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["clinical nurse leader","emergency department","quality improvement","door-to-ECG","STEMI","outcomes","Critical Care Nursing","Medicine and Health Sciences","Nursing"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://repository.usfca.edu/capstone/596"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.
"]},{"key":"dc:title","label":"Title","values":["The Clinical Nurse Leader as Outcomes Manager in the Emergency Department: Improving Door-to-ECG Time for Patients Presenting with Chest Pain"]}]}],"canonical_facts":{"dc:contributor":["Dr. Mary Seed"],"dc:creator":["Estabillo, Arbie"],"dc:date.available":["2017-08-07T07:00:00Z"],"dc:description.abstract":["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.
"],"dc:identifier":["https://repository.usfca.edu/capstone/596"],"dc:subject":["clinical nurse leader","emergency department","quality improvement","door-to-ECG","STEMI","outcomes","Critical Care Nursing","Medicine and Health Sciences","Nursing"],"dc:title":["The Clinical Nurse Leader as Outcomes Manager in the Emergency Department: Improving Door-to-ECG Time for Patients Presenting with Chest Pain"],"thesis:degree_level":["Restricted Project/Capstone - USF access only"],"thesis:degree_name":["Master of Science in Nursing (MSN)"]},"updated_at":"2026-07-24T05:44:00Z"}