What helps patients to survive a heart attack?

Rates of mortality after heart attack vary as much as twofold between the highest- and lowest-performing hospitals, a discrepancy that has not been fully explained.

To explore this question, Research Scientist Leslie Curry, Ph.D., M.P.H.; Elizabeth H. Bradley, Ph.D., professor of public health; and Harlan M. Krumholz, M.D., the Harold H. Hines Jr. Professor of Medicine, visited 11 U.S. hospitals ranked in either the top or the bottom five percent in mortality rates. As reported in the March 15 issue of the Annals of Internal Medicine, the team interviewed 158 staff members, and identified five factors at work in the best hospitals: an organizational culture emphasizing top-notch care; deep involvement of senior managers; participation in clinical decision-making by all health care professionals, including nurses and pharmacists; clear communication and coordinated efforts among departments; and an approach to solving problems based on sharing knowledge and learning from mistakes rather than pointing fingers.

“These essential ingredients are not expensive,” Bradley says. “If we could implement our findings in more hospitals, we could improve quality without adding to costs.”


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