Article

Association Between Hospital Recognition for Nursing Excellence and Outcomes of Very Low-Birth-Weight Infants

The Ohio State University, Columbus, Ohio, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2012; 307(16):1709-16. DOI: 10.1001/jama.2012.504
Source: PubMed

ABSTRACT

Infants born at very low birth weight (VLBW) require high levels of nursing intensity. The role of nursing in outcomes for these infants in the United States is not known.
To examine the relationships between hospital recognition for nursing excellence (RNE) and VLBW infant outcomes.
Cohort study of 72,235 inborn VLBW infants weighing 501 to 1500 g born in 558 Vermont Oxford Network hospital neonatal intensive care units between January 1, 2007, and December 31, 2008. Hospital RNE was determined from the American Nurses Credentialing Center. The RNE designation is awarded when nursing care achieves exemplary practice or leadership in 5 areas.
Seven-day, 28-day, and hospital stay mortality; nosocomial infection, defined as an infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth; and severe (grade 3 or 4) intraventricular hemorrhage.
Overall, the outcome rates were as follows: for 7-day mortality, 7.3% (5258/71,955); 28-day mortality, 10.4% (7450/71,953); hospital stay mortality, 12.9% (9278/71,936); severe intraventricular hemorrhage, 7.6% (4842/63,525); and infection, 17.9% (11,915/66,496). The 7-day mortality was 7.0% in RNE hospitals and 7.4% in non-RNE hospitals (adjusted odds ratio [OR], 0.87; 95% CI, 0.76-0.99; P = .04). The 28-day mortality was 10.0% in RNE hospitals and 10.5% in non-RNE hospitals (adjusted OR, 0.90; 95% CI, 0.80-1.01; P = .08). Hospital stay mortality was 12.4% in RNE hospitals and 13.1% in non-RNE hospitals (adjusted OR, 0.90; 95% CI, 0.81-1.01; P = .06). Severe intraventricular hemorrhage was 7.2% in RNE hospitals and 7.8% in non-RNE hospitals (adjusted OR, 0.88; 95% CI, 0.77-1.00; P = .045). Infection was 16.7% in RNE hospitals and 18.3% in non-RNE hospitals (adjusted OR, 0.86; 95% CI, 0.75-0.99; P = .04). Compared with RNE hospitals, the adjusted absolute decrease in risk of outcomes in RNE hospitals ranged from 0.9% to 2.1%. All 5 outcomes were jointly significant (P < .001). The mean effect across all 5 outcomes was OR, 0.88 (95% CI, 0.83-0.94; P < .001). In a subgroup of 68,253 infants with gestational age of 24 weeks or older, the ORs for RNE for all 3 mortality outcomes and infection were statistically significant.
Among VLBW infants born in RNE hospitals compared with non-RNE hospitals, there was a significantly lower risk-adjusted rate of 7-day mortality, nosocomial infection, and severe intraventricular hemorrhage but not of 28-day mortality or hospital stay mortality.

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    • "Beyond nurse staffing, organizational features of hospitals such as those evaluated through Magnet 1 hospital designation (an international hospital credential that recognizes excellence in nursing standards) (American Nurses Credentialing Center, 2015), specifically better nursing practice environments largely explain improved patient outcomes documented in Magnet 1 hospitals (McHugh et al., 2013). Neonatal intensive care units within Magnet 1 hospitals have demonstrated lower odds of mortality, nosocomial infection, and intraventricular hemorrhage in very low birth weight infants (Lake et al., 2012). These studies provide evidence that specific features of hospital systems such as excellent nursing standards and better nurse staffing are linked to infant outcomes in neonatal intensive care units. "
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