Transcript Nurse Staffing and Quality of Care for Hospitalized Children

Nurse Staffing and Quality of
Care for Hospitalized Children
Barbara A. Mark Ph.D., R.N. FAAN
University of North Carolina at Chapel Hill
David W. Harless PhD
Virginia Commonwealth University
Wallace F. Berman MD
Duke University
Funded by AHRQ: Grant number 2R01HS10153
Background
Support for the nurse staffing – patient
safety/quality/outcomes relationships in
hospitalized patients;
 Dimensions of the problem for hospitalized
children:

– $1 billion in excess charges
– Adverse safety events

Unique needs of pediatric population
– Low marginal reserve capacity
– Dependence on adult caregivers
– Inability to voice concerns about their care
Study Purpose
 To
examine the impact of nurse staffing
on pediatric quality of care:
– In-hospital mortality
– Medication reactions/errors [MR/Es]
– Other complications
Sample
 Pediatric
discharges (< 14 years old)
 178 general acute care hospitals in
California
 2.3 million discharges
 Panel data from 1996 – 2001
 Total observations: 890
 Children’s specialty hospitals excluded
Sources of Data
 California
OSHPD
– Patient discharge abstracts
– Hospital annual disclosure report
 Area
Resource Files
 AHA Annual Survey
 InterStudy HMO Profiler
 Thomson-Medstat risk adjustment
Variables
 Nurse
staffing: RN, LPN, Aide (FTEs/1000
severity adjusted patient days)
 Hospital characteristics: beds; peds inpatient days; presence of PICU/NICU;
ownership; teaching status; percent
Medicaid discharges
 Population characteristics: Unemployment;
income; infant mortality; HMO penetration
Analysis
 Dynamic
Poisson panel model for count
data
– Controls for unobserved heterogeneity
– Includes lagged value of dependent variable
– Includes initial value of dependent variable
 Staffing
levels in natural logs
 Model includes interactions in staffing
levels
Marginal Effects: Mortality
 RN staffing not significant
 0.162 (-0.084, 0.407)
 LPN staffing not significant

0.012 (-0.033, 0.057)
 Aide staffing significant

-0.045 (-0.091, 0.000)
 Dynamic effects not significant
Marginal Effects: MR/Es
 RN staffing significant
 - 0.423 (-0.668, -0.178)
 LPN staffing not significant

0.018 (-0.031, 0.067)
 Aide staffing not significant
 - 0.014 (-0.061, 0.034)
 Dynamic effect (initial value) significant (+)
Marginal Effects: Other
Complications
 RN staffing significant
 -0.360 (-0.515, -0.205)
 LPN staffing significant
 -0.074 (-0.106, -0.042)
 Aide staffing significant
 0.065 (0.033 0.097)
 Dynamic effects significant (+)
Implications
 Effects
of nurse staffing differed across
outcomes
 Lack of effects for mortality
 Need to investigate quantity and quality of
nurses work
 Need to better understand nurse work
processes before mandating minimum nurse
staffing ratios
For further information:
[email protected]