This article is more than 5 years old. Information may no longer be current.
Certain hospital strategies lower mortality rates in patients with acute MI
Click Here to Manage Email Alerts
National data show a twofold difference in 30-day risk-standardized mortality rates following acute MI at top-performing hospitals in the United States compared with the lowest-performing hospitals.
Researchers used a cross-sectional survey of 537 hospitals to examine statistical associations between hospital strategies and hospital risk-standardized mortality rates after acute MI. The survey was sent to acute care hospitals with an annualized acute MI volume of at least 25 patients. The study focused on patients hospitalized with acute MI from January 2008 to December 2009.
The data show that several strategies employed by a few hospitals are associated with significantly lower 30-day risk standardized mortality rates:
- Having monthly meetings to review acute MI care.
- Having cardiologists always on site.
- Encouraging physicians to solve problems.
- Not cross-training nurses from intensive care units for the cardiac catheterization laboratory.
- Having pharmacists rounding on all patients.
- Having physician and nurse champions, as opposed to nurse champions alone.
Hospitals that implemented more of these strategies tended to have lower risk-standardized mortality rates; however, fewer than 10% of hospitals reported using at least four of the five strategies, researchers found. Hospitals had lower risk-standardized mortality rates if hospital clinicians and staff who transported patients to the hospital held monthly meetings to review acute MI cases compared with hospitals that held less frequent or no regular meetings. Monthly meetings were reported in less than 25% of hospitals surveyed. Similarly, having an interventional cardiology, noninterventional cardiology or cardiology fellow on site at all times lowered risk-standardized mortality rates, but this strategy was only implemented by 14% of hospitals that participated in the survey. Researchers found lower risk-standardized mortality rates among hospitals with pharmacists rounding on all patients with acute MI, compared with hospitals where the pharmacists had no specific role. Despite these benefits, only 35% of hospitals surveyed reported pharmacist rounding for patients with acute MI.
“The size of the effect for individual strategies may be viewed as modest; however, in aggregate, they exceed an absolute difference of 1% in risk-standardized mortality rates. 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,” the researchers wrote.
Disclosure: See the study for a full list of disclosures.
Collapse
Click Here to Manage Email Alerts