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Strategies to Lower Death Risk After AMI

Strategies to Lower Death Risk After AMI

Research has shown that the risk of dying from an acute myocardial infarction (AMI) has been steadily decreasing across the United States in recent years. Despite this improvement, there is still substantial variation in 30-day risk-standardized mortality rates (RSMRs) from hospital to hospital. To investigate the causes of variation with RSMRs in these patients, my colleagues and I conducted a cross-sectional survey of 537 hospitals to see what strategies they employed. Published in the May 1, 2012 Annals of Internal Medicine, our findings were combined with data from CMS to determine the links between hospital strategies and mortality rates. 5 Key Hospital Strategies for AMI According to our analysis, five hospital strategies were associated with a clinically important reduced risk of death for patients hospitalized with an AMI: 1) Monthly meetings: Holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital was associated with a 0.70 percentage-point decrease in the RSMR. 2) Cardiologists on site: Always having cardiologists on site lowered the RSMR by 0.54 percentage points. 3) Problem-solving culture: Fostering an organizational environment in which clinicians are encouraged to solve problems creatively lowered the RSMR by 0.84 percentage points. 4) Cross-training nurses: Avoiding cross-training nurses from ICUs for the cardiac catheterization laboratory lowered the RSMR by 0.44 percentage points. 5) Dual champions: Having both physician and nurse champions lowered the RSMR by 0.88 percentage points. Using all five of these strategies was associated with more than a 1% decrease in 30-day RSMRs when compared with hospitals that used none of the strategies. Only six of the hospitals reviewed in our...
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