Hospital management strategies linked to AMI survival rates
MedWire News: Findings from a qualitative US study indicate that inter-hospital variations in acute myocardial infarction (AMI) mortality rates may result from differences in hospital organization and management strategies.
Writing in the Annals of Internal Medicine, the authors report that hospitals with the highest and lowest AMI mortality rates demonstrate substantial differences in five key areas: organizational values and goals, involvement of senior management, broad staff presence and expertise in AMI care, communication and coordination, and problem solving.
Therefore, it appears that "evidence-based protocols and processes, although important, may not be sufficient for achieving high hospital performance in care for patients with AMI," say Leslie Curry (Yale University School of Medicine, New Haven, Connecticut) and colleagues.
Using the 2-year AMI risk-standardized mortality rates (RSMR) of numerous US hospitals to determine AMI care performance, Curry and team selected hospitals with the best (RSMR 11.4% to 14.0%; n=7) and worst (RSMR 17.9% to 20.9%; n=4) performance.
The team found that in contrast to the noted impact of organizational strategies on hospital performance, hospital AMI care protocols and processes, such as use of rapid response teams and medication reconciliation practices, did not significantly differ with hospital AMI care performance.
Curry et al also interviewed 158 staff members involved in AMI care from these 11 hospitals and found that many care practices were used by AMI staff in varying combinations, such that "no single practice or set of practices emerged as key to reducing AMI mortality."
Speaking to MedWire News, Curry advised that healthcare professionals "should remain mindful of the newest technologies and try to adapt protocols and evidence-based processes, but also start to pay attention to these relational aspects of work [that affect AMI care] on a daily basis."
She added: "We hope to encourage clinicians and managers in hospitals to think about these kinds of organizational qualities... and to build and invest in diverse teams."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor