Focus, Flexibility Speed Heart Attack Care

Lessons from the nation's best-responding hospitals can improve centers elsewhere, experts say

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By Ed Edelson
HealthDay Reporter

MONDAY, Feb. 20, 2006 (HealthDay News) -- Researchers have identified key factors that help hospitals treat heart attack patients as quickly as possible.

The next step is to use the findings, which appear in the Feb. 21 issue of Circulation, to improve emergency practice at hospitals everywhere.

It's an unusual study, said lead researcher Dr. Harlan J. Krumholz, because most such studies gather data on a very large scale.

In this case, however, his team focused on just 11 hospitals that were able to consistently restore blood flow to damaged hearts in 90 minutes or less.

"In order to understand what makes great places great you have to get on the ground and talk to people to learn how these places achieve things that are beyond the reach of other places," said Krumholz, a professor of medicine at Yale University Medical School. "When we look at large numbers, we often miss what we can learn by talking to a very small number of places and find out what they are doing."

The 11 hospitals are listed in a national registry of heart attack treatment. They were not identified in the study, and there were some major differences among them -- for example, the hospitals ranged in size from 111 beds to 870 beds.

What they did have in common was getting heart attack patients artery-opening balloon angioplasty in just 90 minutes or less. Time-to-treat ranged from an average of just 55.5 minutes at one hospital to 87 in another.

The hospitals shared eight common characteristics: commitment to an explicit goal of getting the fastest treatment possible; getting support from senior management; innovative protocols; flexibility in changing those protocols if the need arose; having uncompromising leaders; teamwork; quick data retrieval to identify problems; and an organizational culture that could learn from its mistakes.

But there was something paradoxical in the finding, said Elizabeth H. Bradley, director of the Yale Health Management Program, a member of the research team.

"In every organization there are conflicts," Bradley said. "These organizations were able to balance two things -- intense data feedback, but in a blame-free way that could allow changes in rigid protocols."

And while teams typically were headed by a strong leader, "we also found participatory teams that balanced that 'cowboy' leader," she said. "There was an ability to tolerate polar opposites -- flexibility with standardization."

The common denominator in all the hospitals was "amazing people who are so devoted to meeting this problem," Bradley said. "There were a lot of impressive leaders, but also impressive team members."

The research group now is working with "a variety of national organizations" to translate the findings into action that can help improve hospital performance everywhere, Krumholz said.

"We are in the midst of developing a national campaign by the American College of Cardiology," Krumholz said, with educational materials being prepared for distribution in hospitals across the country.

However, simply providing a set of instructions is not enough, Bradley warned.

"You need a whole cultural commitment to making these changes, and that takes a lot more than what you do when you read the book," she said.

More information

To learn the signs and symptoms of heart attack, head to the American Heart Association.

SOURCES: Harlan J. Krumholz, M.D., professor, medicine, and Elizabeth H. Bradley, Ph.D., director, Health Management Program, Yale University School of Medicine, New Haven, Conn.; Feb. 21, 2006, Circulation

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