Examining the substantial variations in mortality rates from heart attack patients in hospitals across the United States led Yale researchers to find relatively inexpensive strategies that could lower mortality rates and open the door for improvement in heart attack treatment nationally.
Reviewing heart attack cases during monthly meetings with emergency medical services and maintaining a positive working environment are two of the relatively inexpensive strategies that can reduce mortality rates among patients with heart attacks, Yale researchers report in a study published in the May issue of Annals of Internal Medicine.
These strategies could potentially save thousands of lives each year, according to lead author Elizabeth H. Bradley, director of the Yale Global Health Leadership Institute. The study is the culmination of five years of research and results from an extensive web-based survey of more than 500 hospitals. This helped the Yale researchers identify some of the best strategies hospitals use to successfully treat heart attack patients.
They found that several factors were significantly associated with lower heart attack mortality rates, including: monthly meetings between hospital clinicians and emergency medical services to review heart attack cases; the constant presence of a cardiologist on site and if not possible, a pharmacist on the daily care team; an encouraging creative problem-solving by clinicians; and physician and nurses working together, rather than nurses alone.
Nonetheless, these strategies were found to be used by less than 10% of the hospitals across the country that were involved in the survey.
“Although mortality rates as a result of heart attacks continue to decrease, substantial variation in these rates among hospitals across the United States persist, and we know little as to why some hospitals are more successful than others in treating patients with heart attacks,” Bradley said. “Our findings identify common features of hospitals with lower mortality rates and open the door for improvement nationally.”
The latest results support the team’s earlier work, which identified five areas that were prominent in higher-performing hospitals and less apparent in lower-performing hospitals.
Bradley said the findings further confirm that key aspects of the organizational environment of hospitals—including effective communication and collaboration among groups, broad staff presence and expertise, and a culture of problem-solving and learning—were apparent in the qualitative work and were statistically associated with higher mortality rates in the quantitative work.
“These strategies we discovered to successfully treat patients with heart attacks were not expensive methods, and therefore, many of these tools and processes can be easily put into place by other hospitals to drastically improve the quality of care provided to these patients,” said senior author Dr. Harlan M. Krumholz, the Harold H. Hines, Jr. Professor of Medicine (Cardiology) at Yale School of Medicine.
Reference: “Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction” by Elizabeth H. Bradley, PhD; Leslie A. Curry, PhD, MPH; Erica S. Spatz, MD, MHS; Jeph Herrin, PhD; Emily J. Cherlin, MSW, PhD; Jeptha P. Curtis, MD; Jennifer W. Thompson, MPP; Henry H. Ting, MD, MBA; Yongfei Wang, MS and Harlan M. Krumholz, MD, SM, 1 May 2012, Annals of Internal Medicine.
DOI: 10.7326/0003-4819-156-9-201205010-00003
The study was funded by the Agency for Healthcare Research and Quality, the Commonwealth Fund, and the United Fund. The work was also funded in part, by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.
Other authors on the study include Leslie Curry, Erica S. Spatz, Jeph Herrin, Emily J. Cherlin, Jeptha Curtis, Jennifer W. Thompson, Henry H. Ting, and Yongfei Wang.
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2 Comments
What exact protocol or treatment makes a difference? This article says that having medical staff work together improves the outcome but what exactly is the staff doing that improves the outcome?
Our study, consistent with our earlier qualitative study, suggests there is not one single treatment of protocol that distinguishes higher performing hospitals. A key conclusion of both papers has been that the organizational internal environment – how staff communicate and coordination among different disciplines and departments, the problem solving norms, engagement of key physician and nursing leaders – is what distinguishes better performing hospitals. In unadjusted analyses, several concrete practices were apparent, as shown in Table 1 of the paper, but equally important was the overall organizational environment…no silver bullet.