Recurring concern
Unreliable ECG use and interpretation for clinical decisions
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Request correctionFirst reported 13 Mar 2015•Latest report 5 Jun 2026
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.
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.
- Reports
- 4
- Individual concerns
- 5
- Date range
- 2015–2026
- Stated actions
- 5
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports 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.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Commence a trial transmitting ECGs to Heart Attack Centre clinicians for early interpretation and specialist referral.
Stated by London Ambulance Service NHS Trust -
Action
Review ECG transmission pilot results and use the findings to inform future pan-London ECG transmission approaches.
Stated by London Ambulance Service NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Position
Existing clinical guidance, support lines and planned ECG transmission provide sufficient mechanisms for paramedic escalation and specialist review.
Stated by London Ambulance Service NHS Trust
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Position
Local ambulance services are responsible for the operational concerns and are best placed to respond to them.
Stated by NHS England
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Conduct the second phase of the ECG process audit to assess the impact of revised documentation and education.
Stated by Manchester University NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
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Position
Producing guidance to teach clinicians ECG interpretation is not considered possible.
Stated by National Institute for Health and Care Excellence
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Position
Developing guidance on teaching clinicians ECG interpretation is not considered within the relevant functions.
Stated by National Institute for Health and Care Excellence -
Position
Royal Colleges, specialist societies and the GMC are identified as responsible for developing ECG interpretation training and guidance.
Stated by National Institute for Health and Care Excellence -
Position
A random audit of selected ECGs is considered unable to provide assurance about interpretation quality.
Stated by Manchester University NHS Foundation Trust -
Position
Auditing all Emergency Department ECGs is considered excessively onerous and likely to distract from patient care.
Stated by Manchester University NHS Foundation Trust
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Review the paramedic standards of proficiency for possible amendments addressing the concerns raised.
Stated by Health and Care Professions Council -
Action
Liaise with the College of Paramedics about whether the paramedic standards of proficiency should be amended.
Stated by Health and Care Professions Council
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
Medical staff dispute that an ECG was indicated for acute breathlessness during the admission.
Stated by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Data last updated 7 September 2026