Abstract 15420: Effective Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction
Background: Despite recent improvements in survival after acute myocardial infarction (AMI), hospitals nationally vary 2-fold in their 30-day risk-standardized mortality rates (RSMRs); nevertheless we have limited information on hospital-level factors that may influence patient outcomes. Accordingly, we sought to identify hospital strategies that were associated with significantly lower RSMRs.
Methods: We surveyed 537 hospitals (reflecting a 91% response rate) to determine whether each of several strategies were in use. We used weighted multivariate regression using data on patients from Centers for Medicare & Medicaid Services to determine the association between hospital strategies and hospital RSMR.
Results: In multivariate analysis, several hospital strategies were significantly associated with RSMRs (average RSMR 15.4%). These included having monthly meetings between hospital clinicians and emergency medical services (EMS) to review AMI cases (absolute rate reduction (ARR) in RSMR 0.70%), having cardiologists always on site (ARR 0.51%), having pharmacists round on patients with AMI (ARR 0.43%), having an organizational environment where clinicians are encouraged to creatively solve problems (ARR 0.93%) and where the effectiveness of changes in care are consistently evaluated (ARR 0.33%). We also found that cross-training critical care nurses for the catheterization laboratory and having nurse champions(s) without physician champions was associated with higher RSMRs. Despite the effectiveness of some strategies, only a minority of hospitals were using these approaches.
Conclusions: Several strategies are associated with significantly lower 30-day risk-standardized mortality rates patients with AMI RSMR According to the Number of Key Strategies Used (Non-parametric test for trend : P < 0.001)
- © 2011 by American Heart Association, Inc.