[NRSKarenRN]

Hospital Death Rate Study Reveals Wide Variations And Stresses Importance Of Registered Nurses

Science Daily — Hospital death rates can be reduced by employing more Registered Nurses and the routine use of care maps or protocols, according to a study in the latest UK-based Journal of Advanced Nursing.

A research team from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to hospital with heart attacks, stroke, pneumonia and blood poisoning. They discovered that deaths within 30 days of admission varied considerably between the 75 hospitals in the study – ranging from ten per cent to 28 per cent and averaging just under 17 per cent.

When they added in the survey results from 3,886 nurses at the hospitals - together with official discharge and death rates, population statistics and insurance plan data – they discovered that a number of factors accounted for 45 per cent of the variation in death rates.

"Our research underlines the need for hospitals to look as carefully at staffing structures and care processes as they already do at accurate diagnosis and appropriate and effective interventions" says lead author Dr Ann Tourangeau.

19 variables were examined to gauge their effect on 30-day death rates. Key findings included:

• A ten per cent increase in the proportion of Registered Nurses employed was associated with six fewer deaths per 1000 discharged patients.
• The death rate also went down by nine per 1000 discharged patients when the number of Baccalaureate-prepared (university graduate rather than diploma qualified) nurses went up by ten per cent.
• A ten per cent increase in adequate staffing and resources (as reported by nurses) was associated with 17 fewer deaths per 1,000 discharged patients. ...

[oramar]

Very important research, thankgoodness someone is doing it.

[lindarn]

Originally Posted by oramar

Very important research, thankgoodness someone is doing it.

My question is, why on earth did it take until the 21st Century, for this research to be conducted? I would think that our "professional organizations", would have realized, (especiatlly after DRGs came into effect 20 years ago), that it was important to validate our presence at the patients' bedside, and our contributions to quality patient care, and positive patient outcomes. This is nothing less than a no brainer.

This clearly illustrates how these organizations have let nurses down. They are truly the root cause of the disgraceful situation that nurses find themselves in today.

Lindarn, RN, BSN, CCRN
Spokane, Washington

[BBFRN]

It took until the 21st century for this research to be conducted, because managed care started messing with nurse staffing ratios in the 1990s. There have been multiple US studies done on this, too. They correlate with the findings in this study. A couple studies have even been able to show that increasing nursing staff either didn't affect hospital profit margins in the long run, or it actually saved them money- depending on how much of a staffing increase there was. This is due to a variety of things, such as decreased incidences of hospital acquired pneumonia, decubs, GIBs, failure to rescue, etc. All of which have been shown to be directly effected by nurse-to-patient ratios. If you want to get down to brass tacks, these things cost lots of money- lots more money than maintaining quality staffing levels. Did you know that treating a case of hospital-acquired pneumonia can cost over $28,000? That's an 84% increase in the last decade. Healing 1 pressure ulcer can cost $14,000-$40,000. Who's paying for that? It's either the patient, or the facility.

Hospitals continue to use stop-gap measures in their staffing practices, instead of looking at long term outcomes. That's the problem here. Managed care companies started this whole cascade, and now they are the ones implementing quality initiatives. Now, some of these actually work (like VAP bundles, etc.), but as long as they, JCAHO, the state BONs, the ANA, and nurses don't demand adequate staffing, the hospitals will continue to use quick-fix, stop-gap measures to change their quality outcomes as quickly as possible to meet short term goals.

Don't get me started on this . Can you tell this subject is very near & dear to my heart?

[leslymill]

Originally Posted by oramar

Very important research, thankgoodness someone is doing it.

???????
I have been in nursing 22 years. We spend thousands every five years in every state researching how high nurse ratios contribute to sentinel events and severe infections. A few even on infant units.


HAS ANYTHING.......ANYTHING .......ANYTHING......BEEN DONE ABOUT IT??????

[BBFRN]

My hospital actually did improve their ratios based on research. Guess what? Their revenues increased, and their quality ratings improved so much, that they started publicly posting them on their website.

[leslymill]

Originally Posted by Baptized_By_Fire

My hospital actually did improve their ratios based on research. Guess what? Their revenues increased, and their quality ratings improved so much, that they started publicly posting them on their website.

They should make a commercial on it to.

Then maybe these greedy folk could see they are digging their own grave.

[NRSKarenRN]

Originally Posted by lindarn

My question is, why on earth did it take until the 21st Century, for this research to be conducted? I would think that our "professional organizations", would have realized, (especiatlly after DRGs came into effect 20 years ago), that it was important to validate our presence at the patients' bedside, and our contributions to quality patient care, and positive patient outcomes.

Guess you missed this news. As ANA member, well aware of study and partcipated in workshop at conventions:

American Nurses Association - Nursing-Sensitive Quality Indicators ...

In March of 1994, the American Nurses Association (ANA) Board of Directors launched a major multi-phase initiative to investigate the impact of health care restructuring on the safety and quality of patient care as well as on nursing. Through Nursing's Safety & Quality Initiative, ANA highlights the strong linkages between nursing actions and patient outcomes.

The Safety & Quality Initiative has focused on educating RNs about quality measurement, informing the public and purchasing/regulating constituencies about safe, quality health care, and investigating research methods and data sources to empirically evaluate the safety and quality of patient care.

Some of these efforts include:

• Principles for Nurse Staffing (1999)
• Implementing Nursing's Report Card: A Study of RN Staffing, Length of Stay, and Patient Outcomes (March 1997)
• Nursing Quality Indicators: Definitions and Implications (June 1996)
• Nursing Quality Indicators: Guide for Implementation (June 1996)
• Nursing Care Report Card for Acute Care (March 1995)
• Continuing education programs on Nursing Quality Outcomes provided by State Nurses Associations (SNAs) and ANA
• Nursing Quality Report Card Request for Data Collection Planning Proposals to financially support the implementation of pilot studies in a sample of hospitals
• National Database of Nursing-Sensitive Quality Indicators Measure Care -- NDNQI
• Continual lobbying by ANA and the SNAs for federal and state legislation requiring the collection, dissemination, and publication of hospital data. Some SNAs have been successful in passing state legislation to protect nurses who speak out about unsafe care. Ongoing efforts are underway to have similar legislation passed nationwide.

ANA remains at the forefront of the movement to free nurses to speak out on behalf of those for whom they care through the introduction of federal whistle blower protection and patient safety legislation.
Development of community indicators to monitor the quality of patient care delivered outside of the acute care hospital setting

Nursing Quality Measurement: A Review of Nursing Studies 1995-2000

Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting

Nursing Quality Indicators Beyond Acute Care: Measurement Instruments


Nursing Quality Indicators Beyond Acute Care: Literature Review



Advances in Patient Safety: Vol. 4
Quality Indicators Sensitive to Nurse Staffing in Acute Care Settings