Magnet-designated hospitals with above-average nurse staffing offer better value than other hospitals, suggests a recent study published in JAMA Surgery.
"We found that patients treated in hospitals with better nursing had significantly lower death rates after surgery," said 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, Philadelphia.
Previous studies have suggested an association between better nursing work environments and superior patient care. But this investigation revealed another discovery that investigators said was rather unexpected and noteworthy: the top-notch care did not come at a top-notch price.
"A surprising finding was that better nurse staffing throughout the hospital does not have to be more costly,” said Linda Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, PA.
“Indeed, we found that Magnet hospitals achieved lower mortality at the same or lower costs by admitting 40 percent fewer patients to intensive care units and shortening length of hospital stay."
BETTER OUTCOMES AT LOWER PRICES
Dr. Aiken, Dr. Silber and others conducted the study to determine whether value (defined as cost vs. quality) differed between Magnet hospitals with better nurse staffing and hospitals with worse nursing environments.
They compared 30-day mortality rates and costs for 25,076 matched pairs of Medicare patients who had surgery in 328 hospitals — 35 Magnet-designated facilities and 293 facilities without the recognition. Patient pairs underwent the same surgical procedure and were alike in a handful of important characteristics, such as age, sex, illness severity, chronic illnesses, and other demographics.
This is what they found:
Magnet hospitals had an average nurse-to-bed ratio of 1.41 compared with 0.69 at non-Magnet hospitals.
30-day mortality rates at Magnet hospitals were 4.8% compared with 5.8% at non-Magnet hospitals.
The cost-per-patient was $163 less at Magnet hospitals compared with non-Magnet hospitals.
When they got down to the nitty-gritty of what types of patients profited most from Magnet-level nursing care, they found patients who were the sickest had the greatest mortality benefit (such patients had a 17.3% mortality rate at Magnet hospitals vs. 19.9% at non-Magnet hospitals). Costs for this patient group averaged $941 more, but that difference was statistically insignificant, researchers said.
However, the widest gap in value between Magnet and non-Magnet hospitals was evident among patients in the second-highest risk group. Their mortality rate at Magnet hospitals was 4.2% compared with 5.8% at non-Magnet hospitals. What’s more, the enhanced care at Magnet facilities cost an average $862 less per patient in this group.
What’s the takeaway? For patients contemplating surgical procedures, it’s pretty clear.
"Magnet designation for nursing excellence offers a way for patients to easily identify hospitals where they are more likely to have good outcomes following surgery," said study co-author Matthew McHugh, PhD, JD, MPH, RN, an associate director at the Center for Health Outcomes and Policy Research.
Nevertheless, researchers were hesitant to imply Magnet designation will automatically lead to better outcomes at lower costs for every organization.
“These results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value,” they wrote, “but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.”