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 Hospitals with well-staffed, top-notch nursing departments had fewer
deaths after surgery than hospitals without those high-quality
nursing departments, researchers found.
"This study is for the person, referring doctor or health policy
analyst asking, 'Would I be better off at this hospital or that
hospital?'" said lead author Dr. Jeffrey Silber, who is the Nancy
Abramson Wolfson Professor in Health Services Research at the
Children’s Hospital of Philadelphia.
Hospitals with the better nursing departments also had fewer
patients die after a surgical complication, the researchers report
in JAMA Surgery.
Hospitals were considered to have good nursing environments if they
had more than one nurse for every hospital bed and so-called Magnet
status, which is a special accreditation from the American Nurses
Credentialing Center.
For the study, the researchers matched 25,752 surgical patients at
35 hospitals with good nursing environments to 25,752 similarly-aged
and equally sick patients at 293 hospitals without those nursing
environments.
Patients were also matched by insurance status, race and surgery
type. Everyone in the study was at least 65 years old.
In the good nursing environments, 4.8 percent of patients died
within 30 days of arriving at the hospital, compared to 5.8 percent
of patients at other hospitals.
The difference in death rates was most pronounced among the least
healthy patients, who were nearly 3 percentage points less likely to
die at hospitals with good nursing environments.
In addition, 7.5 percent of patients at hospitals with good nursing
environments died after complications, compared to 8.9 percent of
patients at other hospitals.
Being in a hospital with a good nursing environment cut the odds of
needing to be in the intensive care unit nearly in half, perhaps
because of better care on the regular patient floors, the authors
say.
"We didn’t expect to see that big of a difference," said Silber, who
is also a professor at the University of Pennsylvania's Perelman
School of Medicine and Wharton School.
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He said hospitals with better nursing environments also provided
better value, with better results for about the same cost. And if
the cost of the additional nurses is excluded, then 30 days of
patient care cost about $2,000 less at hospitals with good nursing
environments.
Ardith Doorenbos, who was not involved with the new study, said
nurse-to-bed ratio and Magnet status are both important factors for
patients to consider.
"You’re going to see a difference in the amount of care and the
quality of care when you have a good nursing environment," said
Doorenbos, who is professor at the University of Washington School
of Nursing and investigator at the UW Medicine Surgical Outcomes
Research Center in Seattle.
Dr. Amir Ghaferi, who co-wrote an editorial on the new study, said
other research has also found better results at hospitals with
Magnet status.
"I think it’s reasonable for patients to look at that and pay
attention to that," said Ghaferi, of the Center for Healthcare
Outcomes and Policy at the University of Michigan in Ann Arbor.
Silber agreed, but cautioned that the new study can't prove that a
good nursing environment causes these better outcomes.
"We’re showing how important the marker of nursing is, but I
certainly wouldn’t ignore other characteristics," he said.
SOURCE: http://bit.ly/1T9DdOu JAMA Surgery, online January 21, 2016.
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