Nurse triage performance is crucial for correct patient management and its main role is to prioritise the large number of patients who are simultaneously admitted to the emergency department (ED) by identifying patients who can safely wait and those who need rapid medical treatment [1], [2]. In recent years, the most widespread and well-studied triage systems have demonstrated a good ability to safely identify patients without urgent pathological conditions, although they have a tendency to overestimate a patient’s priority [3], [4]. Increasing the sensitivity of triage systems could be achieved through the implementation of well-known clinical assessment tools [4].

Currently, interpretation of electrocardiograms (ECGs) by nurses is a debated issue. In addition, in EDs, the ECG, even if performed in triage, is quickly evaluated by a physician present in the ED, slowing down the management of patients and their medical assessment [5], [6].

Growing evidence suggests that adequately trained nurses have a good ability to interpret ECGs and have developed good skills in recognising ECG features associated with potentially serious pathological conditions [7], [8], [9]. In addition, it has been demonstrated that nurses who have been specially trained in ECG interpretation report very good skills in ECG interpretation compared to the good skills of those who have not completed a training course [9]. Despite this evidence, an evaluation of the possible impact of ECG interpretation in the nurse triage context is currently not available. Although the importance of reducing the time between patient admission to the ED and ECG execution in chest pain is well known, none of the major triage systems includes ECG directly in triage [10]. Recently, Dechamps et al. simulated a comparison between the major triage systems and an ECG-based triage assessment and suggested that implementing ECG at the time of triage may improve the predictive ability of the triage [4].

The demonstrated ability of trained nurses to interpret ECGs in the simulations published thus far, the knowledge that rapid detection of a time-dependent cardiovascular condition can positively impact patient outcome and the need to improve the performance of triage systems support the exploration of the possibility of implementing ECG directly in nurse triage [4], [7], [10]. The aim of this study was therefore to evaluate whether ECG interpretation by the triage nurse can improve the performance of triage systems in patients with cardiovascular symptoms.