Elizabeth H. Bradley, Leslie Curry, Ph.D., M.P.H., Erica S. Spatz, M.D., M.H.S., Jeph Herrin, Ph.D., Emily J. Cherlin, M.S.W., Ph.D., Jeptha Curtis, M.D., Jennifer W. Thompson, M.P.P., Henry H. Ting, M.D., M.B.A., Yongfei Wang, M.S., and Harlan M. Krumholz, M.D., S.M.
Several strategies adopted by hospitals appear to be associated with lower mortality rates for patients admitted with a heart attack, clinically known as acute myocardial infarction (AMI). These strategies include: holding monthly meetings between hospital clinicians and emergency medical services to review AMI cases; always having cardiologists on site; fostering an organizational environment that encourages creative problem-solving; not cross-training intensive care unit nurses for the cardiac catheterization laboratory; and having both physician and nurse champions.
Although deaths from heart attack have decreased significantly over the past decade, there is still substantial variation across U.S. hospitals in the number of patients who die within 30 days of hospitalization for AMI. Data from 2005 to 2008 show a more than twofold difference in variation in 30-day risk-standardized mortality rates (RSMRs) across hospitals nationally. Research has shown that certain variables—like medication adherence—can improve these rates, but less is known about strategic factors like communication and problem-solving. In this study, researchers surveyed more than 500 acute care hospitals to explore the associations between their strategies and mortality rates.
While the effect of individual strategies may be modest, the authors estimate that together they lower RSMRs by more than 1 percent. If this change could be achieved nationally, thousands of lives could be saved annually by interventions that involve little risk and relatively few resources.
If hospitals across the country adopted a set of low-risk, low-cost strategies for reducing mortality for heart attack—such as establishing monthly meetings between hospital clinicians and emergency medical services to review cases and encouraging creative problem-solving—thousands of lives could be saved annually.