What’s New in the Patient Safety World
October 2016
Hospital Quality? Ask a Nurse
In a couple past columns we briefly mentioned a study by
McHugh and Stimpfel (McHugh
2012) which showed nurses’ ratings of hospital quality and safety
correlate well with more formal measures. Now a new study done in Swedish
hospitals extends upon that work (Smeds-Alenius
2016). The study used
a survey of nurses in 67 Swedish hospitals and covered over 200,000 general,
vascular, and orthopedic surgical procedures. The researchers found that
hospitals in the highest tertile of nurses reporting
excellent quality of care had a 23% lower odds of 30-day inpatient mortality.
Similarly, hospitals in the highest tertile of nurses
reporting excellent patient safety had a 26% lower odds of 30-day inpatient
mortality. The study validates the previous work of McHugh and Stimpfel and suggests that nurses’ assessments could be
used as legitimate measures of quality and patient safety. The authors do
recognize that inpatient mortality is a crude measure of both safety and
quality (Lilford
2010, Girling 2012). Mortality rates may be appropriate
indicators for some conditions but not others. Moreover, patient-related
factors and patient socioeconomic factors, advance directive issues, plus other
factors impact inpatient mortality rates. Even after risk adjustment for
patient-related variables, mortality rates may be less than ideal measures of
quality or patient safety. The current study was done in Sweden supposedly to
minimize some of the confounding factors seen in the US such as variation in
insurance status and correlated health status.
So could nurse
assessment be used as a formal measure of quality and patient safety? We would
have no qualms about using nurse assessments as an informal measure and we do
often ask nurses their opinion on quality and patient safety in their
hospitals. It might help inform us in our decisions about whether to have a procedure
at their hospital. However, what is unknown is what would happen to the
observed correlation between nurse assessment and mortality rates if this were
to become a formal measure of quality and patient safety. Would nurses continue
to provide honest assessments if they knew that the very viability of their
hospital might be jeopardized by public disclosure of such assessments? We may
never know the answer to that question.
But when we are
asked by someone what is the best way to tell whether a hospital has good
quality and safety we have no problem telling them “ask a nurse”!
References:
McHugh MD, Stimpfel AW. Nurse reported quality of care: A measure of
hospital quality.
Research in Nursing & Health 2012; Article first published online:
21 AUG 2012
http://onlinelibrary.wiley.com/doi/10.1002/nur.21503/abstract
Smeds-Alenius L, Tishelman
C, Lindqvist R, Runesdotter
S, McHugh MD. RN assessments of excellent quality of care and patient safety
are associated with significantly lower odds of 30-day inpatient mortality: A
national cross-sectional study of acute-care hospitals. International Journal
of Nursing Studies 2016; 61: 117–124
http://www.journalofnursingstudies.com/article/S0020-7489%2816%2930075-X/fulltext
Lilford R, Pronovost P.
Using hospital mortality rates to judge hospital performance: a bad idea that
just won't go away. BMJ 2010; 340: c2016
Girling AJ, Hofer TP, Wu J, et al. Case-mix adjusted
hospital mortality is a poor proxy for preventable mortality: a modelling
study. BMJ Qual
Saf 2012; 21(12): 1052-1056 Published Online
First: 15 October 2012
http://qualitysafety.bmj.com/content/21/12/1052.full?sid=53664ed3-dc01-47d1-8be8-d33be15c7132
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