The recording of 12 lead electrocardiograms (ECG) continues to be one of the most useful and commonly performed medical procedures. It is used in diagnosis, risk-stratification management decision making, and assessment of response to therapy.
Interpretation of a 12 lead ECG involves the analysis of several waveforms (P, QRS, ST and T wave) which collectively provide information on the rhythm of the heartbeat and permit the detection of abnormalities that affect normal electrical conduction, allude to structural deformities of the heart or suggest coronary artery perfusion disruptions. Misinterpretation of life-threatening findings on an ECG, such as acute myocardial infarction or unstable angina, has led to substantial compromise in patient care and fatality. Despite their widespread clinical use, several studies have highlighted deficiencies in ECG interpretation among health professionals.
There remains a lack of best practice guidelines for the actual ECG interpretation process. Traditional teaching practices of ECG interpretation didactically focus on memorising morphological patterns of ECG rhythms. Memorizing abstract signals, such as the shape of the complexes seen in ECGs, and associating them with disease processes has its limitations therefore, teaching ECG interpretation remains a challenge for medical educators.
Numerous institutions and universities teach ECG interpretation using their own protocols and techniques. In addition, different interpreters adopt various analytical techniques and nomenclature. For example, experienced ECG interpreters are known to adopt their own unique approach whereas novices will adopt a strict protocol to interpretation. The most current and exhaustive review on the subject states that there is no current evidence based criteria that improves and maintains EKG interpretation skills (13) and that further research is needed to clarify and improve the currently available methods, or devise a new method.
Like many diagnostic tests, proficiency in ECG interpretation requires a combination of knowledge, skill, and practical clinical experience. Knowledge of the pathophysiology of electrocardiographic abnormalities, skill in recognizing common abnormal ECG patterns, and experience in relating the result of the ECG to a patient’s clinical situation are all components of successful interpretation.
Analysing a set of behaviours by a process referred to as task analysis identifies the specific behaviours required in the performance of a specific task. Successful task analysis breaks down a complex sequence of behaviours into component parts. The initial component of task analysis is to identify the behaviours that are to be measured. The formulation of metrics requires breaking down a task into its essential components (task deconstruction) and then tightly defining what differentiates optimal from suboptimal performance. Successful metric development depends on the appropriate and clear identification of what is to be measured and then carefully defining those behaviours in a manner that facilitates their reliable measurement.
Demonstration of pertinent ECG metrics that will incrementally lead to the eventual diagnosis is supported across a range of published literature within this field. Furthermore a lexicon which incorporates a limited set of ECG diagnostic statements that are clinically useful and that do not create unnecessary overlap or contain vague terminology would improve the uniformity of ECG interpretation and ultimately promote better patient care (24).
ECG interpretation criteria consisting of ECG interval measurement prompts, drop down menu options and free text annotations, were adopted into an interactive Smart Form learning tool ANALYSE (systemAtic aNALYsiS Ecg) and evaluated within an ECG interpretation academic module for undergraduate Healthcare Scientists.
ANALYSE is an interactive smart form to support ECG interpretation and diagnosis. It has been devised using Microsoft Word. It consists of ECG interval measurement prompts, drop down menu options and free text annotations areas.
There is a clear role for the ANALYSE form within medical practice particularly in general practice, nursing roles, community and pharmacy facilities and health, well-being and educational institutions. The ANALYSE form will be sought by every institution that educates, researches or diagnosis people using an ECG (medical drug testing facilities etc). The ANALYSE form will work in accordance to the connected health agenda, transforming your care NI proposal and in general remote/telehealth facilities.
School of Health Sciences
University of Ulster