12 Lead electrocardiograms are used in the hospital setting to record electrical signals of the heart. Electrocardiograms are often referred to as ECG or EKG, it is a painless and quick procedure which involves placing 12 electrodes on the patient's body. Electrocardiograms can show abnormalities and arrhythmias of the heart, heart attack and heart failure. In emergency situations it is not always possible to place these leads in the typical location, due to clothing obstructing the site, amputees, and the need for a recording as quickly as possible. This scholarly project was conducted to synthesize and analyze the current research to identify if alternative placement for 12 lead electrocardiograms is as accurate in recording the electrical signals of the heart as standard EKG lead placement. A review of current literature was conducted with four up to date and relevant articles. The evidence concluded that alternative 12 lead electrocardiogram is reasonable in emergency situations. However, there is an increase in the R wave amplitude most commonly in leads I, II and II. The R wave amplitude does stay within the normal range of variations. This scholarly project also proposes a planned test of change based on the Plan Do Study Act (PDSA) model to be used as the foundation to implement evidence-based research into clinical practice that could increase the timeliness of emergency electrocardiogram conduction, and increase awareness of possible increased R wave amplitude with alternative lead placement.