• Alexander Hoang, Amarinder Singh, and Amandeep Singh.
• Emergency Department, Highland Hospital Alameda County, 1411 E 31st St, Oakland, CA 94602, United States of America. Electronic address: AlexanderHoang@stanfordhealthcare.org.
• Am J Emerg Med. 2021 Feb 1; 40: 145-147.

BackgroundMany patients present to emergency departments (ED) in U.S. for evaluation of acute coronary syndrome, and a rapid electrocardiogram (ECG) and interpretation are imperative for initial triage. A growing number of advanced practice practitioners (APP) (e.g. physician assistants, nurse practitioners) are assisting patient care in the ED.PurposeThis study aims to compare the interpretation of ECGs by experienced APPs, each having 10 or more years of experience, with resident physicians and attending physicians.Patients And Methods99 ED providers were stratified into attendings, residents at varying levels, and APPs were tested to interpret 36 ECGs from a database of ECGs initially interpreted to be ST elevation myocardial infarctions, of which 24 were determined to have a culprit lesion by coronary intervention.ResultsAttending physicians were the most sensitive (0.86, 95% CI of 0.80 to 0.92) and specific (0.69, 95% Cl of 0.60 to 0.79) at interpreting ECGs, but APPs and physicians in their first year of practice out of residency were almost equally as sensitive [(0.82, 95% CI of 0.76 to 0.88) and (0.82, 95% CI of 0.76 to 0.88)] and specific [(0.62, 95% cl of 0.52 to 0.73) and (0.65, 95% Cl of 0.56 to 0.75)].ConclusionThis study suggests the possibility of changing ED workflow where experienced APPs can be responsible for initial screening of an ECG, thus allowing fewer interruptions for ED physicians.Copyright © 2020 Elsevier Inc. All rights reserved.

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