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Health Serv Res. 2013 Jun;48(3):972-91. doi: 10.1111/1475-6773.12004. Epub 2012 Oct 22.

Lower mortality for abdominal aortic aneurysm repair in high-volume hospitals is contingent upon nurse staffing.

Author information

1
Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104-4217, USA. wiltse@nursing.upenn.edu

Abstract

OBJECTIVE:

To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing.

DATA SOURCES:

State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey.

STUDY DESIGN:

Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states.

DATA COLLECTION:

Secondary data sources.

PRINCIPAL FINDINGS:

Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001).

CONCLUSIONS:

Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor.

PMID:
23088426
PMCID:
PMC3651774
DOI:
10.1111/1475-6773.12004
[Indexed for MEDLINE]
Free PMC Article

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