A Study of Routine Electrocardiogram Requests for Patients Admitted to Acute Medical Wards

Background: Patients admitted to acute medical wards often undergo routine Electrocardiograms (ECGs), though not always with clear justification. While ACCF/AHA guidelines recommend ECGs for patients with hypertension or diabetes for cardiovascular risk assessment, there are no guidelines for ECG use in patients without cardiac risk factors. Aim: To evaluate the justification for ECGs in patients admitted to Acute medical wards, assessing the need for repeat 12-lead ECGs. Methods: A retrospective cohort study analysed a random sample of acute medical admissions over two months. Data from the first two days of admission included patient diagnosis, bed type, ECG frequency, presenting complaints, clinical findings, and relevant factors such as troponin tests or electrolyte imbalances. Results: Among 50 patients, 257 ECGs were performed in the first two days, with all patients receiving an ECG on admission. However, 70% of ECGs were ordered without specified reasons. ECG frequencies varied, with the most common being every six hours. Troponin tests and electrolyte imbalances were noted in some patients, but only a small percentage required ECG monitoring due to medications or specific diagnoses. Conclusions and Relevance: Frequent, unjustified ECGs increase hospital costs, misdiagnosis risks, and unnecessary follow-ups. Standardized guidelines with risk stratification could optimize ECG use, improving patient care and resource allocation.