In the first study of its kind, researchers at Yale School of Medicine show how hospitals can streamline procedures to reduce the time they take to treat heart attack patients.

The NIH-sponsored study, published in the September Journal of the American College of Cardiology, reports methods for delivery of rapid care based on the experiences of top programs. Studies have found that while every minute counts, few hospitals are able to perform at levels recommended by national guidelines.

To determine how 11 top hospitals, including Yale-New Haven Hospital, achieved their high level of performance, Yale investigators toured facilities and interviewed physicians, nurses, technicians, administrators and others involved in heart attack care.

"We found exceptional, innovative approaches to ensuring rapid treatment of patients," said lead author Elizabeth Bradley, director of the Health Management Program in the Department of Epidemiology and Public Health at Yale. "We used management techniques and flow charts to define achievable times for each step."

"Most of the innovations are about working smarter, not necessarily harder or with more staff," said study senior author Harlan M. Krumholz, M.D., professor of medicine at Yale and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital. "It is about proper organization and flow, planning and preparing and then communicating to everyone what is expected and when. We would like to see best practice become typical practice."

The "best practices" recommendations involved diverse innovations across hospital areas including emergency medical services, collaborations to expedite diagnosis and treatment decisions, transporting patients and staffing critical areas. This work is part of a larger study funded by the National Heart, Lung and Blood Institute and the Patrick and Catherine Weldon Donaghue Medical Research Foundation to identify key success factors for improving quality care in hospitals.