20 Jan Better Nursing Environment Linked To Lower Hospital Mortality
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MedicalResearch.com Interview with:
Jeffrey H. Silber, M.D., Ph.D.
The Nancy Abramson Wolfson Professor of Health Services Research
Professor of Pediatrics and Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine
Professor of Health Care Management
The Wharton School
Director, Center for Outcomes Research
The Children’s Hospital of Philadelphia
Philadelphia, PA 19104
Medical Research: What is the background for this study?
Response: We wanted to test whether hospitals with better nursing work environments displayed better outcomes and value than those with worse nursing environments, and to determine whether these results depended on how sick patients were when first admitted to the hospital.
Medical Research: What are the main findings?
Response: Hospitals with better nursing work environments (defined by Magnet status), and staffing that was above average (a nurse-to-bed ratio greater than or equal to 1), had lower mortality than those hospitals with worse nursing environments and below average staffing levels. The mortality rate in Medicare patients undergoing general surgery was 4.8% in the hospitals with the better nursing environments versus 5.8% in those hospitals with worse nursing environments. Furthermore, cost per patient was similar. We found that better nursing environments were also associated with lower need to use the Intensive Care Unit. The greatest mortality benefit occurred in patients in the highest risk groups.
Medical Research: What should clinicians and patients take away from your report?
Response: Recognized better nursing environments with above average staffing levels identify a set of hospitals that provide better value (lower mortality with similar costs) compared to hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients. These results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value, but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Our study suggests that we can identify hospitals providing superior care and better value by knowing the nursing environment and the staffing levels. Patients can benefit from these results. However, we would like to better understand why and how these better outcomes are produced. Future research should be aimed at discovering exactly what is needed at the hospital to achieve these better results, so that hospitals can know how to change their environments to improve care. Since hospitals are very complex organizations with many different characteristics, knowing why these hospitals perform better requires more study.
Medical Research: Is there anything else you would like to add?
Response: Our study utilized new methods of analysis that allowed us to carefully compare over 25,752 patients treated in hospitals with better environments and staffing to 25,752 very closely matched patients treated at hospitals with worse environments. We could group each patient based on risk of mortality when first admitted to the hospital. When we did this, matching methods allowed us to group matched sets of patients by risk. Therefore, we could determine how much different were outcomes between a patient in a better nursing environment compared to a patient in a worse environment, and see if these differences in outcomes were influenced by initial risk of the patients. They were. The benefits of going to a hospital with a better nursing environment were most apparent in the sicker patients. Something patients and referring physicians may want to know.
Jeffrey H. Silber, M.D., Ph.D. (2016). Better Nursing Environment Linked To Lower Hospital Mortality