St. Marys Hospital in Rochester, Minn., part of the Mayo Clinic, is back on the list after appearing there the first and third years of the study and then dropping off. The 797-bed hospital has made concerted efforts over the past five years to identify and concentrate on the elements of care that are most likely to improve its outcomes, says Mayo cardiologist Henry Ting.
“For every quality-improvement intervention, we measure and evaluate and study until we know how much of a difference we made and why,” he says. “A lot of organizations chase after process improvements and how to perfect them, but we want to make sure each intervention really makes a difference.”
St. Marys' door-to-balloon time is 30 minutes, down from 90 minutes in 2004. Ting knows exactly how much that improvement has affected patient outcomes: Research has shown that every additional 30 minutes correlates to an 8% increase in mortality.
One change contributing to the decrease is an easier to understand consent form at the catheterization lab, written at the sixth-grade level and individualized so patients with conditions like diabetes or renal failure can understand the risks and benefits for their particular conditions.
To cut readmission and mortality rates, Mayo has an initiative to encourage cardiac patients to stay on their medications.
“When patients are prescribed medications, half of them stop taking them within a year, so we're developing decision aids to help them understand their risk of dying or having another heart attack,” Ting says.
The materials feature pictograms with red and green faces representing percentages of patients who live and die under certain conditions. The “medication adherence” pictogram features a significant jump in the number of green faces.
Like all of Mayo's quality-improvement efforts, this one will be carefully tracked.
“A lot of the work we do in quality improvement is not rigorous enough that we know it actually works,” Ting says. “That's the science we need.”
Elizabeth Gardner, a former Modern Healthcare reporter, is a freelance writer based in Riverside, Ill. Reach her at [email protected]