Research Activities, September 2013
Hospitals that collaborate with emergency medical services have fewer heart attack deaths
Emergency medical services (EMS) are a critical component of the care provided to heart attack patients. Evidence suggests that hospitals that collaborate closely with EMS providers tend to have lower mortality rates for heart attack, acute myocardial infarction (AMI). Through interviews with key hospital personnel, a new study characterizes the nature of the EMS-hospital collaborations that may impact mortality. Higher-performing hospitals (those with lower mortality rates) tended to have broad, close, and multifaceted strategies to support collaboration with EMS on heart attack care. Such hospitals demonstrated more investment in and respect for EMS as key professionals in the care process.
Site visits and interviews were conducted at 11 hospitals at the extreme ends of the range for risk-standardized mortality rate for AMI. Higher-performing hospitals ranked in the top 5 percent of performance on 30-day mortality rates from heart attack for 2 consecutive years. Lower-performing hospitals ranked in the bottom 5 percent. Key staff members providing care to patients with heart attack were interviewed about their roles, process of care, and improvement efforts.
Four themes emerged from the study. First, both higher and lower performing hospitals indicated that EMS is important in providing timely care to heart attack patients. Second, higher-performing hospitals had respect for EMS as valued professionals and colleagues. They treated them as professionals rather than just technicians responsible for transport, and did not criticize them if they falsely activated the cardiac catheterization laboratory. Third, higher-performing hospitals also articulated strong communication and collaboration with EMS. Finally, EMS was actively engaged in quality improvement efforts at higher-performing hospitals, with EMS providers represented on hospital quality improvement committees. They also shared performance data regularly with hospital personnel.
The study authors suggest that hospitals work in tandem with EMS providers to develop new protocols to improve care and outcomes of heart attack patients via strong working relationships. Their study was supported in part by AHRQ (HS16929).
See "Hospital collaboration with emergency medical services in the care of patients with acute myocardial infarction: Perspectives from key hospital staff," by Adam B. Landman, M.D., M.S., Erica S. Spatz, M.D., M.H.S., Emily J. Cherlin, Ph.D., and others, in the February 2013 Annals of Emergency Medicine 61(2), pp. 185-195.