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Better Nursing Translates Into Lower Mortality Risk After Surgery

PHILADELPHIA – Being recognized as a Magnet hospital with excellent nursing is an ego boost for hospital staff, but does that translate into better patient care?

A study published recently in JAMA Surgery suggests it does. University of Pennsylvania researchers found that patients undergoing surgery at hospitals recognized for nursing excellence and good nurse staffing have better outcomes at the same or lower costs than other hospitals.

"We found that patients treated in hospitals with better nursing had significantly lower death rates after surgery," explained lead author Jeffrey H. Silber, MD, PhD, director of the Center for Outcomes Research at The Children's Hospital of Philadelphia and senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Silber explained that the outcomes advantage for patients in Magnet hospitals was greater for all patients, but especially for those who were sicker and had more complicated cases.

This study included 25,752 elderly Medicare general surgery patients treated at focal hospitals – mean nurse-to-bed ratio, 1.51 -- and 62 882 patients treated at control hospitals – mean nurse-to-bed ratio of 0.69 -- during 2004-2006 in Illinois, New York, and Texas.

Results indicate that 30-day mortality in focal hospitals, which were larger and more teaching- and technology-intensive, was 4.8% compared to 5.8% in control hospitals. The cost per patient was similar, however, although the actual expenses at focal hospitals were slightly lower.

The greatest mortality benefit of 17.3% vs. 19.9 for focal and control hospitals, respectively, was for patients in the highest risk quintile, with a nonsignificant cost difference of $941 per patient. Results indicate that the greatest difference in value between focal and control hospitals appeared, however, in patients in the second-highest risk quintile, with mortality of 4.2% vs. 5.8%, with a nonsignificant cost difference of $862.

"A surprising finding was that better nurse staffing throughout the hospital does not have to be more costly,” Linda Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, pointed out in a University of Pennsylvania press release. “Indeed, we found that Magnet hospitals achieved lower mortality at the same or lower costs by admitting 40% fewer patients to intensive care units and shortening length of hospital stay.”