Get With the Guidelines
Certifying group: American Heart Association
Crucial, timely interventions when a patient is rushed to the hospital with heart disease or a stroke may mean the difference between life and death. Yet "without a systematic program, with very busy clinicians and multiple physicians and nurses caring for patients, some of these therapies get overlooked," says Gregg Fonarow, professor of cardiovascular medicine at the Ronald Reagan UCLA Medical Center and immediate past chair of the Get With the Guidelines committee. This program prods hospitals to create checklist-style orders so patients are more likely to get necessary therapies, and at the appropriate time. (Angioplasty candidates, for example, benefit most by undergoing the procedure within 90 minutes of arrival.)
Hospitals can participate in the stroke, heart failure, or coronary artery disease modules, or all three. A study last fall found that 355 high-complying hospitals in the program had slightly lower 30-day mortality rates for heart failure and heart attack patients than nonparticipants, which would translate into 1,800 to 3,500 lives saved a year if all U.S. hospitals met the same standards. Still, the program doesn't mean you're guaranteed lifesaving treatments: Of the 1,800 hospitals that have agreed to participate, fewer than a third are currently on the high-compliance gold or silver honor rolls—and for this achievement they are required to meet these standards only 85 percent of the time.
National Accreditation Program for Breast Centers
Certifying group: American College of Surgeons and 15 partnering organizations
Good breast cancer care goes well beyond having eagle-eyed radiologists and competent surgeons. The best comprehensive breast centers also provide social and emotional support. The 27 standards of the NAPBC span the range, from diagnosing with standard-of-care needle biopsies rather than open surgery, to having a team of doctors assess each case before treatment is initiated, to ensuring that every patient is assigned a nurse to help her navigate the system. Still, critics complain that some standards aren't sufficiently rigorous; after initial involvement, the American College of Radiology declined to lend its support because the group felt there was not enough emphasis on the quality of the imaging machines. (The ACR certifies radiology departments only via its own program, the Breast Imaging Center of Excellence.)
Magnet Recognition Program
Certifying group: American Nurses Credentialing Center
Anyone who has had a stint in the hospital won't be surprised to hear that patients fare better at institutions that have happier RNs. One study analyzing 168 hospitals in Pennsylvania, for example, found that a patient's odds of dying were 14 percent lower in hospitals with more supportive nursing environments. The credentialing group, an arm of the American Nurses Association, identifies 88 requirements for nursing empowerment and care, ranging from involvement with hospital decision-making to the implementation of patient-care innovations.
Clinical outcomes (primarily patient falls and pressure ulcer rates) count, and must be better than the national average. "About a third of the hospitals applying don't score high enough on their written documentation to go on to the outside team visit, and another third don't pass the visit to get the designation," says Karen Drenkard, director of the program.
Surprisingly, the nurses union, National Nurses United, opposes the program. "Putting nurses on hospital governance committees diverts them from their core role as patient advocates to become advocates for the institution, which may not have the same agenda. Hospitals can better use the huge amount of money they spend on certification to improve patient care by hiring more bedside nurses," says NNU executive board member Geri Jenkins.