Hospitals with better nursing environments and above-average staffing levels are associated with better value, defined as lower mortality with similar costs, for surgical patients—especially higher-risk patients.

Research that included 25,752 Medicare general surgery patients treated at 35 focal hospitals (mean nurse-to-bed ratio of 1.51) and 293 control hospitals (mean nurse-to-bed ratio of 0.69) revealed a significantly lower 30-day mortality rate at the focal hospitals (4.8% vs. 5.8%; odds ratio [OR], 0.79; 95% CI, 0.73-0.86; P<0.001), with similar costs per patient. 

The greatest mortality benefit was observed among patients in the highest risk quintile (17.3% vs. 19.9% for focal vs. control hospitals; P<0.001). The greatest difference in value was found among patients in the second-highest risk quintile (mortality, 4.2% vs. 5.8% for focal vs. control hospitals; P<0.001). Cost differences were not statistically significant.

Patients at the focal hospitals also had significantly lower 30-day failure-to-rescue rates (7.5% vs. 8.9%; OR, 0.83; 95% CI, 0.76-0.90; P<0.001), were in the intensive care unit less frequently (32.9% vs. 42.9%; OR, 0.55; 95% CI, 0.52-0.57; P<0.001) and had shorter hospital stays (8.4 days vs. 8.6 days; P=0.01) as compared with those at the control hospitals. 

The authors of the study said their results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value, but the findings do show that patients who undergo general surgery at hospitals that have better nursing environments generally do receive care of higher value.

The focal hospitals were identified based on results from a national accreditation program for nursing environment excellence in addition to the nurse-to-bed ratios.

The study was published online Jan. 20 at JAMA Surgery.

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