on February 20, 2006
Published online before print February 20, 2006, doi: 10.1161/CIRCULATIONAHA.105.590133
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Submitted on September 23, 2005
From the Division of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (E.H.B., T.R.W., H.M.K.); Department of Medicine, University of Connecticut School of Medicine, Farmington (L.A.C.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (J.A.M., S.A.R., B.A.B., H.M.K.); Cardiology Division, Department of Medicine, New York University School of Medicine, New York (M.J.R.); Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (R.L.M., H.M.K.); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn (D.N.B.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Conn (E.H.B., H.M.K.). * To whom correspondence should be addressed. E-mail: harlan.krumholz{at}yale.edu.
Background--Fewer than half of patients with ST-elevation acute myocardial infarction (STEMI) are treated within guideline-recommended door-to-balloon times; however, little information is available about the approaches used by hospitals that have been successful in improving door-to-balloon times to meet guidelines. We sought to characterize experiences of hospitals with outstanding improvement in door-to-balloon time during 1999-2002. Methods and Results--We performed a qualitative study using in-depth interviews (n=122) with clinical and administrative staff at 11 hospitals that were participating with the National Registry of Myocardial Infarction and had median door-to-balloon times of Conclusions--Several themes characterized the experiences of hospitals that had achieved notable improvements in their door-to-balloon times. By distilling the complex and diverse experiences of organizational change into its essential components, this study provides a foundation for future efforts to elevate clinical performance in the hospital setting.
Revised on November 28, 2005
Accepted on November 30, 2005
Achieving Rapid Door-To-Balloon Times. How Top Hospitals Improve Complex Clinical Systems
Elizabeth H. Bradley PhD,
90 minutes during 2001-2002, representing substantial improvement since 1999. Data were organized with the use of NUD-IST 4 (Sage Publications Software) and were analyzed by the constant comparative method of qualitative data analysis. Eight themes characterized hospitals’ experiences: commitment to an explicit goal to improve door-to-balloon time motivated by internal and external pressures; senior management support; innovative protocols; flexibility in refining standardized protocols; uncompromising individual clinical leaders; collaborative teams; data feedback to monitor progress and identify problems and successes; and an organizational culture that fostered resilience to challenges or setbacks in improvement efforts.
Key words: health services research • myocardial infarction • quality
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Circulation 2006 113: 1045.
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