Nursing work environment linked to better surgical value

Editor's Note

Hospitals with better nursing work environments and above-average staffing levels were associated with better surgical value (ie, lower mortality with similar costs), especially for higher-risk patients, researchers from the University of Pennsylvania, Philadelphia, found.

The study compared outcomes and patient costs at 35 focal hospitals recognized nationally as having good nurse working environments and nurse-to-bed ratios of 1 or greater with 293 control hospitals without such recognition and with nurse-to-bed ratios less than 1.

Compared with controls, surgical patients at focal hospitals had lower 30-day mortality (4.8% vs 5.8%) and failure-to-rescue (7.5% vs 8.9%) rates, were in the ICU less often (32.9% vs 42.9%), and had shorter lengths of stay (8.4 vs 8.6 days). In-hospital and 30-day costs were similar for both groups.

The greatest mortality benefit occurred in patients in the highest risk quintile. The greatest difference in value appeared in patients in the second-highest risk quintile.

1Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia 2Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia 4Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia 5Center for Outcomes Research, Children's Hospital of