1. Identify the ECG performed closest to arrival, either before or after hospital arrival, but not more than 1 hour prior to arrival. If unable to determine which ECG was performed closest to arrival, select “No.”
2. Start with review of your SIGNED tracing. Evaluate the findings line by line. Determine if the terms or phrases are Inclusions or Exclusions. If you have an Exclusion, select “No,” regardless of other documentation, and there is no need to review further.
3. In the absence of an Exclusion on the tracing, proceed to other interpretations that you can say clearly refer to the closest to arrival ECG. Documentation which cannot be tied to the ECG performed closest to arrival should not be used. Do not cross reference findings between interpretations unless otherwise specified. If you encounter an Exclusion in any of the other interpretations, select “No,” regardless of other documentation, and there is no need to review further.
4. At the end of your review, if you have no Exclusions, and either the signed ECG tracing or interpretations of this ECG include at least one Inclusion, select “Yes.” Otherwise, select “No.”

• ECG interpretation is defined as:
  • 12-lead tracing with name/initials of the physician/advanced practice nurse/physician assistant (physician/APN/PA) who reviewed the ECG signed, stamped, or typed on the report, or
  • Physician/APN/PA notation of ECG findings in another source (e.g., progress notes).
• Do not measure ST-segments or attempt to determine if there is an LBBB from the tracing itself.
• Consider a tracing 12-lead if it has the appropriate markings (the presence of multiple leads: I, II, III, AVR, AVL, AVF, V1-V6).
• If ECG documentation outside of a tracing is not specified as 12-lead, assume it is 12-lead unless documentation indicates otherwise.
• Disregard any description of an MI or ST segment that is not on either the Inclusion list or the Exclusion list.
• If documentation is contradictory (e.g., “ST-elevation” and “No ST-elevation”), select “No.”
• If at least one interpretation describes an LBBB as old, chronic, or previously seen, all LBBB findings should be disregarded.
• If any of the Inclusion terms are described using the qualifier “possible,” disregard that finding (neither Inclusion nor Exclusion).
• Do not consider “subendocardial” an MI “location” (e.g., “acute subendocardial MI” should be disregarded).

PHYSICIAN/APN/PA DOCUMENTATION ONLY

• Consultation notes
• ECG reports
• Emergency department record
• History and physical
• Progress notes