Ten Minute Tracing: progress we can all be proud of
In the care of patients with possible STEMI, a timely ECG is one of the most important first steps we take. It is often the test that changes everything. A rapid ECG can identify a life-threatening coronary occlusion, set urgent treatment in motion, and help ensure that precious minutes are not lost. When the ECG is delayed, recognition is delayed, decisions are delayed, and reperfusion is delayed. That is why the goal of obtaining an ECG within 10 minutes of first medical contact (FMC) matters so much.
The reason this matters is simple: delay is not harmless. In STEMI, every minute to reperfusion counts, whether the patient is heading for primary PCI or fibrinolysis. A widely cited estimate suggests that each 30-minute delay to reperfusion is associated with about a 7.5% relative increase in 1-year mortality, which is roughly 3% to 4% for every 15 minutes. Registry data have also shown rising 6-month mortality with treatment delay for both PCI and fibrinolysis. Just as importantly, the consequences are not only about survival. Delayed reperfusion is also associated with larger infarcts, worse left ventricular function, and more heart failure. A systematic review found that every 1-hour delay to reperfusion was associated with a 4% to 12% increased risk of new-onset heart failure.
And yet, anyone working in Emergency care knows getting a timely ECG is not always easy.
Busy waiting rooms, competing demands, patient flow challenges, staffing pressures, and the sheer unpredictability of the ED environment can all make it difficult to consistently achieve a ten-minute ECG. In our work through the Manitoba ACS Network Ten Minute Tracing initiative, we have seen just how much variability can exist, even among sites caring for similar patients. Across several sites in Winnipeg and Brandon, median FMC-to-ECG times have varied widely. Some sites have remained well above target, while others have shown that much better performance is possible.
That variability has been one of the most important lessons of this work. It tells us that delays are not inevitable. More importantly, it tells us that improvement is achievable.
One of the most encouraging parts of the Ten Minute Tracing experience has been seeing what front-line teams can accomplish when a few key processes are refined. At one pilot site, median FMC-to-ECG times started at roughly 30 minutes. Early efforts such as staff education, faster patient movement, and improved responsiveness from those performing ECGs brought those times down significantly. But the real breakthrough came when the process was redesigned so that possible cardiac patients could be identified and acted on earlier, right at first contact by the registration clerk. Once that happened, the site was able to consistently achieve median times below the 10-minute target.
That kind of progress is exciting. It shows that meaningful improvement does not always require more staff or major new resources. Often, it comes from clearer processes, better teamwork, and empowering people to act quickly.
Our recent data continue to show both the challenge and the promise. At some sites in Winnipeg, median times remain above goal. At other sites, performance has come much closer to target, and one site has shown excellent results. A large ED outside of Winnipeg has also demonstrated encouraging performance. These findings remind us that the ten-minute goal is realistic, even in busy acute care settings, and that success can be achieved in different environments.
A major strength of this work is that the lessons are practical and evidence-based. Again and again, five key ingredients have emerged as essential to success.
First, possible STEMI symptoms must be recognized immediately at first medical contact.
Second, the team member who identifies those symptoms must be empowered to request an urgent ECG right away.
Third, the person performing the ECG must be readily available and the communication pathway must be simple and dependable.
Fourth, the ECG must be easy to obtain, with an accessible location and a smooth process to move the patient quickly into position.
Fifth, the tracing must be interpreted without delay so that action can follow immediately.
These may sound straightforward, but together they make all the difference. When any one of these steps breaks down, time is lost. When they work well together, the system works well for the patient.
What has made this initiative especially rewarding has been the opportunity to work closely with Emergency Department teams. We have been impressed, and honestly inspired, by the commitment, creativity, and determination shown by nurses, registration staff, ECG technologists, health care aides, physicians, and managers. The achievements at these sites did not happen by chance. They happened because front-line teams cared deeply, engaged with the problem, and found ways to make things better.
That deserves recognition.
Too often in health care we focus only on the gaps. The Ten Minute Tracing experience has reminded us that we should also celebrate progress. The improvements made at these sites are real. They reflect thoughtful teamwork and a shared commitment to better care for patients with possible ACS and STEMI. Working with these ED teams has been a very positive and rewarding experience, and we are grateful for their openness, collaboration, and impressive accomplishments.
The message now is a simple one: keep going.
A timely ECG is not just a performance measure. It is often the first life-saving step in the care of a patient with STEMI. We know the barriers are real, but we also know that improvement is possible. The successes we have already seen should encourage all of us. By focusing on early recognition, empowered action, rapid ECG access, efficient flow, and immediate interpretation, we can continue to improve.
Let us keep learning from one another, keep refining our processes, and keep aiming for ten-minute tracing. The work matters, the progress is real, and our patients are the ones who stand to benefit most.
