Achieving rapid door-to-balloon times - How top hospitals improve complex clinical systems

被引:220
作者
Bradley, EH
Curry, LA
Webster, TR
Mattera, JA
Roumanis, SA
Radford, MJ
McNamara, RL
Barton, BA
Berg, DN
Krumholz, HM
机构
[1] Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Div Hlth Policy & Adm, New Haven, CT 06520 USA
[2] Univ Connecticut, Sch Med, Dept Med, Farmington, CT USA
[3] Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA
[4] NYU, Sch Med, Dept Med, Div Cardiol, New York, NY USA
[5] Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
[6] Yale Univ, Sch Med, Dept Psychiat, New Haven, CT USA
[7] Yale Univ, Sch Med, Dept Med, Robert Woods Johnson Clin Scholars Program, New Haven, CT 06510 USA
关键词
health services research; myocardial infarction; quality;
D O I
10.1161/CIRCULATIONAHA.105.590133
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Fewer than half of patients with ST-elevation acute myocardial infarction (STEMI) are treated within guideline-recommended door-to-balloon times; however, little information is available about the approaches used by hospitals that have been successful in improving door-to-balloon times to meet guidelines. We sought to characterize experiences of hospitals with outstanding improvement in door-to-balloon time during 1999 - 2002. Methods and Results - We performed a qualitative study using in-depth interviews ( n = 122) with clinical and administrative staff at 11 hospitals that were participating with the National Registry of Myocardial Infarction and had median door-to-balloon times of <= 90 minutes during 2001 - 2002, representing substantial improvement since 1999. Data were organized with the use of NUD-IST 4 ( Sage Publications Software) and were analyzed by the constant comparative method of qualitative data analysis. Eight themes characterized hospitals' experiences: commitment to an explicit goal to improve door-to-balloon time motivated by internal and external pressures; senior management support; innovative protocols; flexibility in refining standardized protocols; uncompromising individual clinical leaders; collaborative teams; data feedback to monitor progress and identify problems and successes; and an organizational culture that fostered resilience to challenges or setbacks in improvement efforts. Conclusions - Several themes characterized the experiences of hospitals that had achieved notable improvements in their door-to-balloon times. By distilling the complex and diverse experiences of organizational change into its essential components, this study provides a foundation for future efforts to elevate clinical performance in the hospital setting.
引用
收藏
页码:1079 / 1085
页数:7
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