Despite a substantial decline in deaths from heart attack in the past decade, there is still substantial variation in 30-day risk-standardized mortality rates (RSMRs) from hospital to hospital. Researchers who surveyed 537 hospitals have identified several hospital strategies that were strongly associated with lower mortality rates for patients hospitalized for heart attack.
Lower mortality rates were more likely to occur when the hospital culture encouraged clinicians to creatively solve problems, physicians and nurses acted as champions to improve the quality of care, hospital clinicians met at least monthly to review care with staff who transported patients to the hospital, and cardiologists were always present in the hospital.
Hospital strategies associated with higher mortality rates included having only nurse champions and cross-training critical care nurses for the cardiac catheterization lab. Although the size of the effect for individual strategies was modest, taken together, they exceeded an absolute difference of 1 percent in RSMRs. If a change this large could be achieved nationally, thousands of lives could be saved yearly by using interventions that have negligible risk and could be implemented with relatively few new resources, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16929).
See “Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction” by Elizabeth H. Bradley, Ph.D., Leslie A. Curry, Ph.D., Erica S. Spatz, M.D., and others in the Annals of Internal Medicine 156, pp. 618-626, 2012.