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

Hospital executives pursue external recognition to improve market share and demonstrate institutional commitment to quality of care. The Magnet Recognition Program of the American Nurses Credentialing Center identifies hospitals that epitomize nursing excellence, but it is not clear that receiving Magnet recognition improves patient outcomes. Using Medicare data on patients hospitalized for coronary artery bypass graft surgery, colectomy, or lower extremity bypass in 1998–2010, we compared rates of risk-adjusted thirty-day mortality and failure to rescue (death after a postoperative complication) between Magnet hospitals and non-Magnet hospitals matched on hospital characteristics. Surgical patients treated in Magnet hospitals, compared to those treated in non-Magnet hospitals, were 7.7 percent less likely to die within thirty days and 8.6 percent less likely to die after a postoperative complication. Across the thirteen–year study period, patient outcomes were significantly better in Magnet hospitals than in non-Magnet hospitals. However, outcomes did not improve for hospitals after they received Magnet recognition, which suggests that the Magnet program recognizes existing excellence and does not lead to additional improvements in surgical outcomes.

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“…It confirms the findings of two studies conducted in convenience samples, with comparable effect sizes. [13,14]…”

Section: Discussionmentioning

confidence: 99%

“…Three cross-sectional studies have identified favorable outcomes for Medicare discharges,[12] neonates,[13] and surgical patients. [14] However, it is unclear whether the successful pursuit of Magnet recognition leads to improved patient outcomes.…”

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confidence: 99%

Hospitals In ‘Magnet’ Program Show Better Patient Outcomes On Mortality Measures Compared To Non-‘Magnet’ Hospitals

et al. 2015

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“…Neonatal intensive care units within Magnet ® 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.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

Hallowell

Rogowski

Spatz

et al. 2016

International Journal of Nursing Studies

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Context Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting Cross sectional analysis combining nurse survey data with infant discharge data. Participants A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor’s degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.

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“…(9–11) On the contrary others have shown superior outcomes for several conditions including falls,(28) mortality after trauma,(29) and outcomes of very low birth weight infants. (30) Friese et al(7) using a cohort of elderly surgical Medicare patients demonstrated that hospitalization in a Magnet hospital was associated with lower 30-day mortality and rates of failure-to-rescue. Similar results were demonstrated in an earlier national study,(31) and a regional analysis in Pennsylvania.…”

Section: Discussionmentioning

confidence: 99%

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Bekelis

Missios

MacKenzie

2018

British Journal of Neurosurgery

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Purpose The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. Materials and Methods We performed a cohort study of patients undergoing neurosurgical procedures from 2009–2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. Results During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Conclusions Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

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

Cited by 84 publications

References 32 publications

Hospitals In ‘Magnet’ Program Show Better Patient Outcomes On Mortality Measures Compared To Non-‘Magnet’ Hospitals

Hospitals In ‘Magnet’ Program Show Better Patient Outcomes On Mortality Measures Compared To Non-‘Magnet’ Hospitals

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

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