Implementing a teleECG service

A project team from Hunter New England Local Health District (HNELHD) has successfully implemented a teleECG service that links specialist nurses with staff in small rural hospitals.

The service, based on a teleECG model of care, supports staff caring for patients with suspected acute coronary syndrome. The project team developed the model following a research project that found there was a strong evidence base for the model’s effectiveness.¹ A pilot was then run as part of an Agency for Clinical Innovation-led initiative to establish a statewide model of care. The model was co-designed with input from nursing, medical, information technology, biomedical, imaging and operational executive stakeholders to ensure clinical integration, operational sustainability and workforce alignment. The teleECG service was then successfully implemented in HNELHD and demonstrated improved patient access to timely cardiac care in rural and regional settings.

A service led by nurse practitioners

Implementation of the teleECG service leveraged established network and hospital relationships, technology (including a real-time notification system and an ECG management platform), and the sponsorship and infrastructure put in place during the research and pilot phases of the project. The project team designed the service to integrate with existing health pathways, protocols and guidelines for patient assessment and management.

As a nurse practitioner-led service, it provides timely identification and management of time-sensitive and potentially life-threatening acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), non-STEMI and unstable angina (or UAP). STEMI requires urgent diagnosis and intervention to reduce the risk of heart failure or death, while non-STEMI and unstable angina demand early specialist assessment to prevent reinfarction and improve survival.

TeleECG connects nurse practitioners with clinicians in smaller rural hospitals using virtual care technology. This supports expert ECG interpretation, patient assessments and evidence-based decision support. The service enhances equitable access to quality cardiac care in rural and regional areas and complements the NSW State Cardiac Reperfusion Strategy.

TeleECG also helps ensure other acute cardiac conditions can be assessed and managed in a timely manner, enhancing the delivery of safe and effective cardiac care. Other conditions include arrhythmias, atrial fibrillation, which is common and increases stroke risk if missed, and acute heart failure, which is often complex and time-sensitive.

Delivering high-quality and efficient cardiac care

One nurse practitioner is responsible for operating the service each day. They deliver comprehensive care to an average of 7,500 to 8,000 patients annually across rural HNELHD emergency departments. Despite limited staffing, the service consistently delivers high-quality, scalable and efficient cardiac care.

Post-implementation, the service has:

• Maintained levels of accurate and timely recognition of acute coronary syndrome.
• Improved time to reperfusion (the restoration of blood flow) for STEMI since the clinical trial phase of the project, being a median of 43 minutes during operational hours and 73 minutes outside of hours.
• Resulted in a lower 30-day readmission for patients admitted with any cardiac condition during teleECG operating hours (4.6%) compared to out-of-hours (10.7%). 30-day mortality also reduced (2% in-hours compared to 3.7% out-of-hours).

The service aligns with emerging evidence on acute coronary occlusion myocardial infarction, reflected in the Australian Guidelines for Acute Coronary Syndrome 2025,² which requires advanced expertise to detect subtle yet critical ECG changes, combined with holistic clinical assessment. The service is uniquely positioned to meet this demand through its centralised, real time and nurse-led structure. The role of teleECG in detecting and managing other acute cardiac conditions – which can be prevalent, high-risk and often under-diagnosed – improves patient outcomes, reduces hospital admissions and enhances continuity of care.

Planned service enhancements, including automated ECG worklists and referral mechanisms, are expected to expand the service’s capacity and precision in identifying and managing a broader range of complex cardiac presentations in rural hospitals.

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