A checklist manifesto: Can a checklist of common diagnoses improve accuracy in ECG interpretation?
| Publication Type | Academic Article |
| Authors | Nickerson J, Taub E, Shah K |
| Journal | Am J Emerg Med |
| Volume | 38 |
| Issue | 1 |
| Pagination | 18-22 |
| Date Published | 03/29/2019 |
| ISSN | 1532-8171 |
| Keywords | Cardiovascular Diseases, Checklist, Electrocardiography, Emergency Medicine, Internship and Residency, Syncope |
| Abstract | OBJECTIVE: To determine whether a checklist of possible etiologies for syncope provided alongside ECGs helps Emergency Medicine (EM) residents identify ECG patterns more accurately than with ECGs alone. METHODS: We developed a test of ten ECGs with syncope-related pathology from ECG Wave-Maven. We reviewed the literature and used expert consensus to develop a checklist of syncope-related pathologies commonly seen and diagnosed on ECGs. We randomized residents from three New York EM residency programs to interpret ECGs with or without a checklist embedded into the test. RESULTS: We randomized 165 residents and received completed tests from 100 (60%). Of those who responded, 39% were interns, 23% PGY2s, and 38% were PGY3s or PGY4s. We found no significant difference in overall test scores between those who read ECGs with a checklist and those who read ECGs alone. In post-hoc analysis, residents given a checklist of syncoperelated etiologies were significantly more likely to recognize Brugada (96% vs. 78%, p = 0.007), long QT (86% vs. 68%, p = 0.03) and heart block (100% vs 78%, p = 0.003) as compared to those without a checklist. Those with a checklist were more likely to overread normal ECGs (72% vs 35%, p = 0.0001) compared to those without a checklist, finding pathology where there was none. CONCLUSION: Using a checklist with common syncope-related pathology when interpreting an ECG for a patient with clinical scenario of syncope may improve residents' ability to recognize some clinically important pathologies; however it could lead to increased interpretation and suspicion of pathology that is not present. |
| DOI | 10.1016/j.ajem.2019.03.048 |
| PubMed ID | 30952602 |