Original Title: Utilisation judicieuse des moniteurs cardiaques à l’urgence

Authors' objectives: In Quebec, there are currently no province-wide recommendations for the appropriate use of cardiac monitors in emergency departments. Triage nurses rely on their own judgment or on orientation to emergency department criteria, where these exist, to decide whether to use cardiac monitoring. Given the lack of clear guidelines for cardiac monitoring in emergency departments, the Ministère de la Santé et des Services sociaux asked INESSS to develop a decision-support tool for nurses to promote the appropriate use of cardiac monitoring in the province's emergency departments

Authors' results and conclusions: RESULTS (#1 THE ELECTROCARDIOGRAM IN EMERGENCY DEPARTMENTS): The electrocardiogram (ECG) can be easily administered in emergency departments and does not require the same time and resources as cardiac monitoring. For these reasons, the choice of whether to perform an ECG at the time of triage is left to clinical judgment of nurses, and the clinical tool does not contain a list of specific criteria to guide this decision. The tool does, however, cover the use of the initial ECG when ACS is suspected, and specifies abnormal ECG findings that may justify the use of cardiac monitoring in emergency departments. As such, the initial ECG is recommended for all patients with chest pain and should be performed within ten minutes of the patient's arrival in the Emergency Department when ACS is suspected. (#2 CARDIAC MONITORING RECOMMENDED):There are many patients with chest pain in emergency departments, and cardiac monitoring is recommended only for those at risk of ACS, since cardiac monitoring in lowrisk patients will not improve their condition. For this reason, cardiac monitoring should be used in patients with chest pain only when a severity criterion or three or more cardiovascular risk factors are present, in order to identify patients at higher risk of ACS during triage. Cardiac monitoring should be performed only to detect arrhythmias when at risk, and not to monitor vital signs. (#3 CARDIAC MONITORING TO CONSIDER): In special situations, such as palpitations with ECG changes, suspected aortic dissection and electrolyte disorders, the decision to initiate cardiac monitoring will depend on the resources available in the hospital, the physician's decision or the patient's risk of developing an arrhythmia. These indications have been grouped together in a “to be considered” section of the tool, with the aim of promoting the appropriate use of cardiac monitoring. (#4 CARDIAC MONITORING NOT RECOMMENDED): A section containing certain indications where cardiac monitoring is not recommended is also provided, to raise nurses' awareness of the irrelevance of cardiac monitoring in certain cases of syncope, chest pain or known arrhythmia. CONCLUSION: To maximize the proper use of cardiac monitors in emergency departments, cardiac monitoring must be performed in the right clinical situation. Without replacing the clinical judgment of nurses, this work should contribute to a more appropriate use of cardiac monitoring and, consequently, promote targeted management, appropriate use of healthcare resources and a reduction in the costs generated by inappropriate use. Harmonization of practices across Quebec hospitals is desirable and will depend on the distribution of the clinical tool associated with this report, and the adoption of the clinical information and recommendations by the healthcare professionals involved.

Authors' recommendations: Following an iterative process with members of the Advisory Committee, in which clinical information and recommendations from the literature, contextual elements and the perspective of various stakeholders consulted were triangulated, a series of findings and recommendations were formulated. These recommendations are included in this report, as well as in the resulting decision-support tool designed primarily for nurses.

Authors' methods: A systematic search of clinical practice guidelines published between January 2015 and March 2024 on cardiac monitoring and the clinical conditions in which monitoring is recommended in the emergency department was conducted. • The identification of practice guidelines in databases and grey literature was conducted in collaboration with a scientific information advisor (librarian). Documents were selected on the basis of pre-established criteria, and their quality was assessed using the AGREE II tool. • An Advisory Committee made up of clinicians from various specialties and areas of expertise (emergency physicians, nurses, cardiologists) was involved in establishing the recommendations. • The usability of the tool produced was tested by prospective users working in hospitals.

Authors' identified further research: The need for updating the recommendations will be assessed four years from the date of publication, based on the progress of scientific data and the evolution of clinical practices, as well as the needs of the health and social services network.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/utilisation-judicieuse-des-moniteurs-cardiaques-a-lurgence.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/utilisation-judicieuse-des-moniteurs-cardiaques-a-lurgence.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)