Objective: Over the past decade interest in patient safety and quality of care in hospitals has been increasing. This study identifies and analyzes trends in six hospital-acquired, adverse patient outcomes to determine if rates of adverse outcomes have fallen or increased over time, and to determine the relationship between changes in rates of adverse outcomes to changes in nurse staffing and market characteristics of hospitals.
Study Design: The presence of hospital-acquired urinary tract infections, sepsis, pneumonia, deep vein thrombosis, upper gastrointestinal bleeding, and shock/cardiac arrest were coded from hospital patient discharge abstracts for years 1988-1997. Raw rates for each outcome, and rates adjusted for changes over time in risk due to diagnosis, age, and presence of specific chronic conditions were calculated.
Population: Patients admitted for medical conditions in California hospitals, 1988-1997. Additional analysis is underway for Washington, Wisconsin, Florida, and Massachusetts and results will be available for the meeting, including the relationship of outcome rates and changes in nurse staffing. Concepts or Variables Studied: Nursing sensitive adverse patient outcomes, patient risk adjustment
Methods: Comparison of an alternative method (propensity score risk adjustment) to control for a patient’s risk of experiencing an adverse outcome with traditional risk adjustment methods in analyzing rates of hospital acquired nursing sensitive patient outcomes over time.
Findings: For all but shock/cardiac arrest, rates of adverse patient outcomes increase over time. After adjusting for changes in patient characteristics between 1988 and 199, rates for sepsis, deep vein thrombosis, and upper gastrointestinal bleeding continued to show increases, and rates for urinary tract infections and pneumonia were unchanged.
Conclusions: The decline in shock/cardiac arrest and increase in upper gastrointestinal bleeding may be due to increased use of thrombolytics over the period studied. Overall, however, these data provide no evidence that patient safety improved over this time period for these outcomes.
Implications for Policy, Delivery or Practice: The adverse outcomes studied are influenced by the organization of care and level and training of nursing staff, and generally cannot be attributed to specific, charted lapses in treatment. Patient safety and quality improvement efforts need to pay increased attention to outcomes like these and monitor whether they improve or worsen over time.
Primary Funding Source: Agency for HealthCare Research and Quality The category to which abstract is being submitted: Health-related services and systems research
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