reading EKGs- an advanced privilege?

Purrsx2 · Mar 13, 2016

I have two questions for the community:

1) Is orthopedic surgeon allowed to sign off on EKG strip just because he is an "MD"?

2) Who has more exposure to reading EKG - psychiatrist, pediatrician, plastic surgeon or FNP/PA/primary care doctor?

valx92 · Mar 13, 2016

i guess technically the orthopedic doc would be allowed, but i hope he wouldn't do it without consulting cardiology.

NPmimzy75 · Mar 14, 2016

Thanks for all the comments! I agree that it is mostly a billing issue. In practice, I am seeing the patient in the ER for the cardiologist (who is likely in the cath lab) assessing the patient including interpreting the EKG. I'm making the decision about the treatment course including going to the cath lab at that time. The EKG is "signed" by one of the cardiologists the following day. I don't go back and use that signed EKG for anything. It stays in the computer system. My decisions are made by the real time EKGs in the chart that I've ordered.

The question I'm wondering about is, do anyone's priviledges specifically mention interpreting EKGs?

I think the bigger issue in the situation that this has stemmed from was an isolated incident, maybe with an individual that may need closer monitoring or a system that needs scrutiny. My facility is trying to turn it into a broader issue involving all NPs (and PAs) in our organization in general. I plan to express that this is not appropriate or necessary. It is within our scope to interpret and treat based on these tests. If they want a physician to do the "official read" for billing and liability purposes, it really doesn't change our day to day.

bklynbaby · Mar 16, 2016

Ive never considered reading an EKG a privilege.

I read EKGs at my facility. if there is ever a concern for cardiac changes there is always a cardiac fellow on call who can remotely look at an EKG for me. There are also in house medicine consults available.

All EKGs done at my hospital are given a final interpretation by a cardiologist attending usually within 24 hours.

in my experience if there is ever a question refer to a cardiologist regarding EKG changes,

Advanced Practice Columnist / Guide · Mar 16, 2016

Thanks for all the comments! I agree that it is mostly a billing issue. In practice, I am seeing the patient in the ER for the cardiologist (who is likely in the cath lab) assessing the patient including interpreting the EKG. I'm making the decision about the treatment course including going to the cath lab at that time. The EKG is "signed" by one of the cardiologists the following day. I don't go back and use that signed EKG for anything. It stays in the computer system. My decisions are made by the real time EKGs in the chart that I've ordered.
The question I'm wondering about is, do anyone's priviledges specifically mention interpreting EKGs?
I think the bigger issue in the situation that this has stemmed from was an isolated incident, maybe with an individual that may need closer monitoring or a system that needs scrutiny. My facility is trying to turn it into a broader issue involving all NPs (and PAs) in our organization in general. I plan to express that this is not appropriate or necessary. It is within our scope to interpret and treat based on these tests. If they want a physician to do the "official read" for billing and liability purposes, it really doesn't change our day to day.

I think given the fact that you work with the Cardiologist and is the go to person in the ED for making decisions about intervention or not based on EKG's, it should be added to your privileges officially (but agree with you that it shouldn't be the case for any other PA or NP not in your role).

In our setting, there are basic in-patient privileges that all NP's have and that includes ordering and interpreting diagnostic tests and labs (i.e., EKG). As a critical care NP, I can tell an abnormal EKG from one that doesn't warrant treatment but the final decision about any percutaneous coronary intervention is not up to me to decide, a Cardiology provider must be consulted for that.

I think that's what's different between being able to read an EKG and having the final say on the next step. Those in specialty services have specific privileges that not everyone has by virtue of their specialty (i.e., lines, sedation, intubation are part of my privileges as a critical care NP).

IsabelK · Mar 16, 2016

When something goes wrong and someone decides to sue the hospital, the lawyer will say: Who did sign off that EKG? Will anyone be able to keep a straight face when saying the NP/PA?

Since I work in an LTC, I do sign off on the EKG and then get a formal read usually the next day from the cardiologist who reads them for the portable x-ray/EKG/ultrasound company. I sign off on everything except DNR/DNI because legally I can't yet. The physicians are usually only in the building once a week.

Gypsy Moon · Nov 7, 2016

I am a med/surg tele nurse and can interpret telemetry rhythms. When it comes to EKG's I have always had the docs sign off on them. If I chose to learn to interpret EKG's then I would feel confident in my skills. The other day a new doctor asked me on the phone to interpret one and I said it was outside my scope. He said I should take a class because it is within my scope. I agree with the other comments that if you study it and use it then you can possibly interpret them but I am not really sure what the state board of nurses would say in your state. That is why I was searching on this question in the first place. If you are an APN working in cardiology for a cardiologist I would be confident in your skills in most cases but in your shoes I would be looking at frequent learning opportunities. The last time I studied for a tele test I tried the beginning course at the ECG Academy which is an online rhythms opportunity. The class has straightforward and also obscure presentations and if I were to get serious about EKG interpretation I would be following on their chalkboard where they post the problems and do continuing education.

CoolLikeThat · Nov 8, 2016

During my RN career I do not ever recall an NP signing off on EKGs and as an NP I am happy to have someone else have the responsibility for that job. MDs in my hospital can read them, but if there is ever any question that bad boy gets read by cards. Can I read them - yes but I am not the expert and would prefer not to have that responsibility.

Another issue is the reading of X-rays. Again, I have worked in several facilities where line placement x-rays are only good when the approval is given by radiology. I can read them fine but I never write the order to use a line until confirmed by radiology. I try to CMA as much as possible. I have run into many NP/PAs who feel they can do everything better than an MD and that is fine and good but I like my license and want to keep it for a bit longer.

Gypsy Moon · Nov 8, 2016

Well, I met with my supervisors and they said that it is definitely within my scope to read them if I have the training. They said I could go to the EKG class in January. My one supervisor is an EMT and a nurse (he has an associates in nursing) and he said he is responsible to read them all the time. So at least in Wyoming the nurses can read the EKGs according to the supervisor and the new doctor.

But I agree with the above comment that I always have radiology sign off on the reports before using lines unless another doctor looks at them and OKs it. I guess if they start asking me to read xrays next then I will have to comment about it.