Lower MI Death Risk Linked to Five Strategies (CME/CE)
To investigate the causes of that variation, Bradley and colleagues conducted a cross-sectional survey of 537 hospitals to see what strategies they employed.
Those findings were combined with data from the Centers for Medicare & Medicaid Services to determine any links between hospital strategies and mortality rates.
In a multivariate analysis, five strategies were significantly associated with lower mortality and, taken together, were associated with "clinically important" differences in the 30-day risk-standardized mortality rates.
Specifically: Holding monthly meetings between hospital clinicians and staff who transported patients to the hospital to review cases was associated with a 0.70 percentage point decrease in the standardized mortality rate.
Avoiding cross-training nurses from intensive care units for the cardiac catheterization laboratory lowered it by 0.44 percentage points.
Having physician and nurse champions rather than nurse champions alone lowered it by 0.88 percentage points.
Using more of the five strategies decreased the mortality rate, with a non-parametric test for the trend significant at P <0.001, they found.
Most of the strategies, they argued, do not need much in the way of additional resources but do "require new ways of working across disciplinary and organizational groups."
The exception is having cardiologists on site at all times, which may be "impractical for many institutions," they noted.
Bradley and colleagues cautioned that the study is a snapshot and can't say anything about cause and effect.
As well, they noted, some of the strategies they found important may actually be markers for some other aspects of care that actually lower risk.