UMass Memorial gets top ranking

Heart surgery program among safest in nation

WORCESTER - Nearly three years after its heart surgery program was suspended, UMass Memorial Medical Center in Worcester now ranks among the safest in the country, according to federal figures released today.

The national mortality rate, which estimates a patient's risk of dying after a heart attack while still at a particular hospital or after they have been discharged, was 16.1 percent from July 2006 through June 2007. At UMass Memorial, the death rate among 299 eligible patients was 12 percent. At Lahey Clinic in Burlington, the other Massachusetts hospital whose outcomes were significantly better than the national rate, the death rate among 198 patients was 12.6 percent.

As a patient, said Dr. John F. Keaney, chief of cardiovascular medicine at UMass Memorial, "it's what you want to know: Are you going to get out of the hospital or not?"

The Centers for Medicare & Medicaid Services gathered data from more than 4,000 hospitals across the country on people older than 65 who died within 30 days of coming to a hospital with a heart attack.

The results, posted today online at www.hospitalcompare.hhs.gov, were adjusted to account for older or sicker patients, recognizing that some hospitals care for people who might have lower chances of surviving a heart attack. While the lower-than-average mortality rate being reported today at UMass Memorial shows how the hospital performs when it comes to heart attack care, the numbers also reflect a reversal from September 2005, when a troubling number of deaths after cardiac bypass operations shuttered elective cardiac surgery.

The state had begun tracking deaths in the 30 days after bypass surgery in 2002. When UMass Memorial had a mortality rate significantly higher than the state average, the entire program was halted for six weeks while outside reviewers tried to find out why. A report to the state Department of Public Health identified problems in leadership, communication, and monitoring of patient outcomes, making more than 70 recommendations for improvement.

In response, the cardiac program was revamped. The hospital as a whole suffered a hit to its reputation while an estimated $22 million vanished because of lost referrals from community cardiologists alone, according to a paper in the American Journal of Medical Quality written by Dr. Walter H. Ettinger Jr., hospital president. The crisis was a catalyst for change, according to Dr. Robert A. Phillips, medical director of the hospital's Heart and Vascular Center of Excellence.

"We were humbled by suboptimal performance and took that as an opportunity to excel," he said about the new Medicare results. "It validates all the hard work we've been doing. It validates all the systemic changes."

In a heart attack, a blocked blood vessel starves the heart of blood, eventually causing heart muscle to die. Time equals muscle, heart specialists say, so prompt diagnosis and treatment from paramedics to emergency doctors to cardiologists are the keys to saving a patient's life. The road to survival increasingly runs through the cardiac catheterization lab, where doctors thread a thin tube through a blood vessel in the leg up to the arteries that feed the heart. A tiny balloon at the tube's tip can break up a blood clot clogging a coronary artery and restore blood flow to the heart, and a wire-mesh stent can be left behind to keep the vessel propped open.

Door-to-balloon time - a clock that starts ticking the minute the patient comes through the emergency room door and stops when the blockage is dislodged - has become the standard for success. UMass Memorial says its unofficial time ranges from 34 to 54 minutes, better than the national goal of 90 minutes or less set by the American College of Cardiology and the American Heart Association.

Medicare's Hospital Compare site posts outcomes for heart attack and many other categories of care, including results from a patient satisfaction survey. Public reporting is designed for consumers who want to find out how well hospitals perform, but the indicators also have powerful effects on the hospitals themselves as they stack themselves up against their peers.

"I think it is the case that after the public reporting of the [cardiac surgery] situation at UMass Memorial, their performance improved. That's indisputable," Paul Dreyer, the state's director of healthcare safety and quality, said last month.