Improving ECG Interpretation Skills Among Healthcare Providers at Aswan University Hospitals: A Clinical Audit

BACKGROUND: Electrocardiogram (ECG) interpretation is a fundamental skill in cardiovascular diagnostics, crucial for identifying various cardiac conditions and guiding appropriate clinical decisions. Misinterpretation can lead to adverse patient outcomes. This clinical audit aimed to assess and improve the commonest life-threatening cases that can be faced during daily practice at Aswan University Hospitals, Aswan, Egypt. METHODS: This clinical audit involved 124 participants in the second cycle, including house officers, medical officers, and registrars, from Aswan University Hospitals. Data were collected using a pre-made questionnaire and analyzed. A six-stage approach to ECG interpretation was used as the standard for assessment, covering electrical activity presence, ventricular rate, QRS rhythm regularity, QRS width, atrial activity presence, and the relationship between atrial and ventricular activity. A first audit cycle assessed baseline knowledge (N=102), followed by an intervention (training and educational materials based on the new local standards), and then a second audit cycle (N=124) to measure improvement. Ethical approval was obtained from the hospital's institutional review board and ethics committee. RESULTS: Significant improvements were observed in ECG interpretation skills between the first and second audit cycles. The ability to identify electrical activity increased from 67 (65.7%) to 118 (95.2%), a 29.5% improvement. Knowledge of calculating heart rate improved by 37.0%, from 47 (46.1%) to 103 (83.1%). Recognition of regular heart rate improved from 66 (64.7%) to 100 (80.6%), a 15.9% improvement. Identifying changes in QRS width showed the largest improvement of 40.2%, from 33 (32.4%) to 90 (72.6%). The ability to identify atrial activity increased by 6.7%, from 68 (66.7%) to 91 (73.4%). Finally, recognizing the relationship between atrial and ventricular activity improved by 27.8%, from 49 (48.0%) to 94 (75.8%). CONCLUSION: This clinical audit demonstrated a substantial improvement in ECG interpretation skills among healthcare providers at Aswan University Hospitals after the intervention. This reflects enhanced adherence of staff to guidelines, thus optimizing patient care. Continued re-auditing is recommended to ensure sustained implementation of these improved standards.