Five specific organizational practices significantly associated with lower risk-standardized mortality rates

In-hospital mortality after acute myocardial infarction (AMI) has decreased significantly over the past several decades but varies considerably among U.S. hospitals. In a quantitative analysis building on previous qualitative research (JW Cardiol Mar 30 2011), these investigators sought to identify specific strategies associated with low 30-day risk-standardized mortality rates (RSMRs) after AMI.


Of 590 hospitals surveyed, 537 (91%) responded. The surveyed hospitals had an overall weighted mean RSMR of 15.4% (standard deviation, 1.5; range, 11.5%–21.7%). Multivariate analysis revealed several strategies that were significantly associated with lower-end RSMRs:

•     Holding monthly meetings to review AMI cases with hospital clinicians and staff who transport patients to the hospital

•     Having an on-site cardiologist at all times

•     Cultivating an environment in which clinicians are encouraged to solve problems creatively

•     Avoiding cross-training of intensive care unit nurses for cardiac catheterization laboratories

•     Having at least one quality-improvement champion who is a physician rather than a nurse

The more of these strategies hospitals employed, the lower their RSMRs tended to be. A secondary analysis, in which having a cardiologist always on site was excluded from the variables, produced essentially the same findings.


Citation(s):

Bradley EH et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med 2012 May 1; 156:618.