Unreliable ECG use and interpretation for clinical decisions
First to latest report 13 Mar 2015 — 5 Jun 2026
Reports that mention this concern
4
Times this concern has been raised
5
Stated actions linked to this concern
5
What this concern includes
Includes failures in the dedicated ECG clinical-use process, including deciding when an ECG is indicated, performing or obtaining it, interpreting automated or clinician readings, ensuring staff competence, auditing interpretation and arranging specialist review of abnormal traces.
What is not included
Excludes general cardiac assessment, diagnostic testing or clinical-decision failures where ECG use or interpretation is not the material unsafe condition.
Excludes failures in treatment or observation after an ECG has been reliably obtained, interpreted and appropriately escalated.
Excludes generic training, staffing, documentation or communication deficiencies unless they directly impair ECG use, interpretation or specialist review.
Excludes failures involving other cardiac electrical recordings unless the assertion explicitly supports the same ECG process.
Do not duplicate the existing narrower registry concern focused solely on unreliable interpretation of cardiac electrical recordings when the assertion does not also concern ECG indication, acquisition, competence, audit or escalation.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust1
Health and Care Professions Council1
London Ambulance Service NHS Trust1
Manchester University NHS Foundation Trust1
National Institute for Health and Care Excellence1
NHS England1
NHS trust3
Executive non-departmental public body2
Health and care professional regulator1
Reports and published responses 4 reports
See individual reports that have raised this concern, and the actions taken in response
North London
Concerns raised1
Lack of a clear pathway for specialist doctor interpretation of ECG traces when paramedics decide not to convey patients to hospital
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
London Ambulance Service NHS Trust
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
London Ambulance Service NHS Trust
Commence a trial transmitting ECGs to Heart Attack Centre clinicians for early interpretation and specialist referral.
London Ambulance Service NHS Trust
Review ECG transmission pilot results and use the findings to inform future pan-London ECG transmission approaches.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
London Ambulance Service NHS Trust
Existing clinical guidance, support lines and planned ECG transmission provide sufficient mechanisms for paramedic escalation and specialist review.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
Local ambulance services are responsible for the operational concerns and are best placed to respond to them.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised2
Lack of authoritative national guidelines for ECG use and interpretation across clinical settings
Failure to undertake wider audit of pre-discharge ECG interpretation in the Emergency Department and Acute Medical Unit
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Manchester University NHS Foundation Trust
National Institute for Health and Care Excellence
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Manchester University NHS Foundation Trust
Conduct the second phase of the ECG process audit to assess the impact of revised documentation and education.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
National Institute for Health and Care Excellence
Producing guidance to teach clinicians ECG interpretation is not considered possible.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
National Institute for Health and Care Excellence
Developing guidance on teaching clinicians ECG interpretation is not considered within the relevant functions.
Outside remitThe respondent said that this matter was outside its role or authority.
National Institute for Health and Care Excellence
Royal Colleges, specialist societies and the GMC are identified as responsible for developing ECG interpretation training and guidance.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester University NHS Foundation Trust
A random audit of selected ECGs is considered unable to provide assurance about interpretation quality.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Manchester University NHS Foundation Trust
Auditing all Emergency Department ECGs is considered excessively onerous and likely to distract from patient care.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Birmingham and Solihull
Concerns raised1
Lack of formal testing of paramedics’ 12-lead ECG interpretation
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Health and Care Professions Council
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Health and Care Professions Council
Review the paramedic standards of proficiency for possible amendments addressing the concerns raised.
Health and Care Professions Council
Liaise with the College of Paramedics about whether the paramedic standards of proficiency should be amended.
Nottinghamshire
Concerns raised1
Lack of clear guidelines for ECG decision-making in acute breathlessness
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Medical staff dispute that an ECG was indicated for acute breathlessness during the admission.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.