Three research posters at Emergency Nursing 2025 cut to the heart of daily ED practice: shaving minutes off door-to-EKG time, confronting secondary traumatic stress, and standardizing behavioral health care to reduce risk of violence.
Across different settings, the conclusions from these projects can be summed up with one thread: Targeted, team-driven changes supported by data can improve patient outcomes, staff safety and nurse well-being.
SMART Framework for Door-to-EKG Improvements
Justin Burshtynsky, MSN, RN
At Stanford Health Care in Stanford, California, Justin Burshtynsky, MSN, RN, led a team using the SMART methodology to beat the 10-minute American Heart Association benchmark for door-to-EKG time with a combination of workflow adjustments, equipment prioritization and updated criteria for identifying cardiac risk.
“We refined what it means to be a STAT EKG to meet the below 10 minutes AHA guideline,” Burshtynsky explained. “We moved registration and the quick-look nurse to have a line of sight right to the front door. That way, they could identify incoming patients right away.”
Building on that, the team leveraged the Epic Rover mobile app to introduce a real-time countdown tied to each patient’s arrival. This not only kept EKG timing transparent but gave techs a clear visual cue that reinforced urgency.
“The timer is linked to ED arrival time, so techs know how long they have to get this EKG done.”
The intervention led to a 30 percent improvement in median door-to-EKG time, from 11 minutes to seven minutes. Peak performance reached five minutes in August 2024, sustained below 10 minutes for more than six months.
“We did not anticipate that significant of an impact,” Burshtynsky reflected. “It was definitely a culture change.”
Secondary Traumatic Stress
With support from an ENA Foundation research grant, Alison Camarda, PhD, RN, CEN, CPEN, SANE, from Southwestern Vermont
Alison Camarda, PhD, RN, CEN
Medical Center, surveyed 275 ED nurses from 41 states, finding that more than half scored in the severe range for secondary traumatic stress.
“It became clear that it isn’t an individual problem,” Camarda said. “We need to look at the source of the trauma, which includes the workplace, and improve systems.”
She pointed to elements of the physical environment and workflow, like nurses triaging patients with little time for connection, a constant stream of high-acuity cases, and roles that often isolate staff midshift. These conditions, she suggests, make emotional recovery difficult.
“We found that nurses in Magnet hospitals had higher secondary traumatic stress. That wasn’t what we expected, and it raises questions rather than conclusions,” Camarda said.
The model explained 25 percent of the variance in secondary traumatic stress. The Professional Practice Work Environment Index accounted for 9 percent, with available resources linked to lower scores.
Safer Behavioral Health Care
Sandy E. Martinez, MSN, RN, CEN
At PIH Health in Whittier, California, Sandy E. Martinez, MSN, RN, CEN, and her team tackled the persistent safety risks tied to behavioral health care in the ED. Their approach centered on improving communication during patient handoffs and implementing physical screening protocols to close gaps in recognition and response.
“We developed a Safety Coach handoff tool, so sitters have consistent information, and we added wanding with EMR documentation to make sure those kinds of high-risk details didn’t get missed,” Martinez said.
Following rollout, wanding compliance reached 100percent, and code gray activations increased as staff became more comfortable recognizing and acting on risk. Injury rates declined from 0.06 to 0.05 per patient encounter.
Bottom Line
For EDs grappling with time-to-diagnosis rates, nurse stress or safety gaps in behavioral health care, these projects offer real-world solutions with practical implementation tips. Stop by the Experience Hall to talk with the researchers about their studies and on-the-ground insights.