{"id":318,"date":"2024-11-06T16:35:58","date_gmt":"2024-11-06T16:35:58","guid":{"rendered":"https:\/\/iims.uthscsa.edu\/isrn\/?page_id=318"},"modified":"2024-11-06T16:35:58","modified_gmt":"2024-11-06T16:35:58","slug":"resource-adequacy-in-hospitals-that-care-for-acutely-ill-children","status":"publish","type":"page","link":"https:\/\/iims.uthscsa.edu\/isrn\/resources\/ereading-room\/abstracts\/resource-adequacy-in-hospitals-that-care-for-acutely-ill-children\/","title":{"rendered":"Resource Adequacy in Hospitals that Care for Acutely Ill Children"},"content":{"rendered":"

[vc_row][vc_column width=”2\/3″][vc_column_text css=””]<\/p>\n\n\n\n\n\n
Primary Author:<\/td>\nSharon Barton, PhD, RN, PCNS-BC<\/td>\n<\/tr>\n
Co-Principal Investigators\/Collaborators:<\/td>\nLinda Aiken, PhD, Jeannie Cimiotti, DNSc, RN, Kathleen Gorman, MSN, RN, NEA-BC, Douglas Sloane, PhD<\/td>\n<\/tr>\n
Organization<\/td>\nThe Children’s Hospital of Philadelphia, University of Pennsylvania School of Nursing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Abstract<\/h2>\n

Purpose<\/h3>\n

The purpose of this study was to compare nurse reports on availability of nursing resources and quality of care provided to children in general acute care hospitals and children\u2019s hospitals<\/p>\n

Background<\/h3>\n

Few reports address the quality of health care delivered to children despite the estimated 1.8 million who are admitted to hospitals annually. Hospitalized children are vulnerable to medical errors and preventable adverse outcomes; yet, little evidence is available on outcomes in acute care facilities that specialize in the care of children.<\/p>\n

Materials & Methods<\/h3>\n

Survey data from 2006 were available from 3,819 pediatric nurses working in 498 acute care hospitals in four states (CA, FL, NJ, PA). Hospitals were classified as: 1) general acute care hospital with a pediatric unit, 2) a children\u2019s hospital within a larger acute care hospital, and 3) freestanding children\u2019s hospitals. Staffing and resource adequacy was assessed using the Practice Environment Scale of the Nursing Work Index. Logistic regression models were used to estimate the effect of staffing and resource adequacy on outcomes.<\/p>\n

Results<\/h3>\n

Nurses working in freestanding children\u2019s hospitals reported caring for fewer patients and a larger percent were baccalaureate prepared. In a children\u2019s hospital within a hospital there was a significant increase in the odds of nurses reporting not enough staff to get the work done, inadequate support services, and not enough time to discuss patient problems by 43%, 47% (36% in general hospital) and 49%, respectively. In a multivariate model estimating differences between hospital types, high staffing and resource adequacy was significantly associated with a 58% decrease in the odds of surveillance left undone and 56% decrease in the odds of missed changes in patients conditions.<\/p>\n

Conclusion<\/h3>\n

Our findings suggest that there may be differences in nursing resources and outcomes between freestanding children\u2019s hospitals, children\u2019s hospitals within larger institutions, and pediatric units within general hospitals, and that differences in the adequacy of resources may be largely responsible for differences in outcomes.<\/p>\n

Bibliography<\/h3>\n

Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623.<\/p>\n

Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. [Research Support, N.I.H., Extramural]. Journal of Nursing Administration, 38(5), 223-229.<\/p>\n

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993.<\/p>\n

Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nursing Research, 49(3), 146-153.<\/p>\n

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., . . . Smith, H. L. (2010). Implications of the California Nurse Staffing Mandate for Other States. Health Services Research. doi: HESR1114 [pii]10.1111\/j.1475-6773.2010.01114.x [doi]<\/p>\n

Aiken, L. H., Sloane, D. M., Lake, E. T., Sochalski, J., & Weber, A. L. (1999). Organization and outcomes of inpatient AIDS care. Medical Care, 37(8), 760-772.<\/p>\n

Andersen, B. M., Lindemann, R., Bergh, K., Nesheim, B. I., Syversen, G., Solheim, N., & Laugerud, F. (2002). Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. Journal of Hospital Infection., 50(1), 18-24.<\/p>\n

Archibald, L. K., Manning, M. L., Bell, L. M., Banerjee, S., & Jarvis, W. R. (1997). Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatric Infectious Disease Journal, 16(11), 1045-1048.<\/p>\n

Berenson, R. A., Bodenheimer, T., & Pham, H. H. (2006). Specialty-service lines: salvos in the new medical arms race. Health Affairs, 25(5), w337-343.<\/p>\n

Burns, K. H., Casey, P. H., Lyle, R. E., Bird, T. M., Fussell, J. J., & Robbins, J. M. (2010). Increasing prevalence of medically complex children in US hospitals. Pediatrics, 126(4), 638-646.<\/p>\n

Cimiotti, J. P., Haas, J., Saiman, L., & Larson, E. L. (2006). Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med, 160(8), 832-836.<\/p>\n

Dillman, D. A. (2000). Mail and internet surveys the tailored design method. New York: John Wiley & Sons, Inc.<\/p>\n

Donoghue, A. J., Nadkarni, V. M., Elliott, M., Durbin, D., & American Heart Assocation National Registry of Cardiopulmonary Resuscitation, I. (2006). Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics, 118(3), 995-1001.<\/p>\n

Friese, C. R., Lake, E. T., Aiken, L. H., Silber, J. H., & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. [Research Support, N.I.H., Extramural
\nResearch Support, Non-U.S. Gov’t]. Health Services Research, 43(4), 1145-1163.<\/p>\n

Haley, R. W., & Bregman, D. A. (1982). The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. Journal of Infectious Diseases, 145(6), 875-885.<\/p>\n

Harbarth, S., Sudre, P., Dharan, S., Cadenas, M., & Pittet, D. (1999). Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infection Control & Hospital Epidemiology, 20(9), 598-603.<\/p>\n

Hazinski, M. F. (1997). Anatomic and physiologic differences between children and adults. In D. L. Levin & F. C. Morriss (Eds.), Essentials of Pediatric Intensive Care (2nd ed.). New York: Churchill Livingstone.<\/p>\n

Institute of Medicine. (2004). Keeping Patients Safe: transforming the work environment of nurses (prepublication copy) (pp. 435). Washington, DC: National Academies Press.<\/p>\n

Kutney-Lee, A., Lake, E. T., & Aiken, L. H. (2009). Development of the Hospital Nurse Surveillance Capacity Profile. Research in Nursing & Health, 32(2), 217-228.<\/p>\n

Lake, E. T. (2002). Development of the practice environment scale of the Nursing Work Index. Research in Nursing & Health, 25(3), 176-188.<\/p>\n

Lake, E. T., & Friese, C. R. (2006). Variations in nursing practice environments: relation to staffing and hospital characteristics. Nursing Research, 55(1), 1-9.<\/p>\n

Marcin, J. P., Rutan, E., Rapetti, P. M., Brown, J. P., Rahnamayi, R., & Pretzlaff, R. K. (2005). Nurse staffing and unplanned extubation in the pediatric intensive care unit. Pediatric Critical Care Medicine, 6(3), 254-257.<\/p>\n

Mark, B. A., Harless, D. W., & Berman, W. F. (2007). Nurse staffing and adverse events in hospitalized children. Policy, Politics, & Nursing Practice, 8(2), 83-92.<\/p>\n

Miller, M. R., Elixhauser, A., & Zhan, C. (2003). Patient safety events during pediatric hospitalizations. [Comparative Study
\nMulticenter Study Research Support, Non-U.S. Gov’t]. Pediatrics, 111(6 Pt 1), 1358-1366.<\/p>\n

Miller, M. R., & Zhan, C. (2004). Pediatric patient safety in hospitals: a national picture in 2000.[erratum appears in Pediatrics. 2004 Sep;114(3):907]. Pediatrics, 113(6), 1741-1746.<\/p>\n

National Quality Forum. (2004). National Voluntary Consensus Standards for Nursing-Sensitive Care: An Initial Performace Measure Set. National Quality Forum.<\/p>\n

Odetola, F. O., Gebremariam, A., & Davis, M. M. (2010). Comorbid illnesses among critically ill hospitalized children: Impact on hospital resource use and mortality, 1997-2006. Pediatric Critical Care Medicine, 11(4), 457-463.<\/p>\n

Odetola, F. O., Gebremariam, A., & Freed, G. L. (2007). Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Pediatrics, 119(3), 487-494.<\/p>\n

Owens, P., Thompson, J., Elixhauser, A., & Ryan, K. (2003). Care of Children and Adolescents in U.S. Hospitals (Vol. HCUP Fact Book No. 4). Rockville, MD: Agency for Healthcare Research and Quality.
\nSaiman, L., Cronquist, A., Wu, F., Zhou, J., Rubenstein, D., Eisner, W., . . . Della-Latta, P. (2003). An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infection Control & Hospital Epidemiology, 24(5), 317-321.<\/p>\n

Silber, J. H., Gleeson, S. P., & Zhao, H. (1999). The influence of chronic disease on resource utilization in common acute pediatric conditions. Financial concerns for children’s hospitals. Archives of Pediatrics and Adolescent Medicine, 153(2), 169-179.<\/p>\n

Silber, J. H., Romano, P. S., Rosen, A. K., Wang, Y., Even-Shoshan, O., & Volpp, K. G. (2007). Failure-to-rescue: comparing definitions to measure quality of care. Medical Care, 45(10), 918-925.<\/p>\n

Silber, J. H., Rosenbaum, P. R., & Ross, R. N. (1995). Comparing The Contributions Of Groups Of Predictors – Which Outcomes Vary With Hospital Rather Than Patient Characteristics. Journal Of The American Statistical Association, 90(429), 7-18.<\/p>\n

Silber, J. H., Williams, S. V., Krakauer, H., & Schwartz, J. S. (1992). Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Medical Care, 30(7), 615-629.<\/p>\n

Smith, H. L. (2008). A double sample to minimize bias due to non-response in a mail survey. In P. G. A. Ruiz-Gazen , D. Haziza, and Y. Till\u00e9 (Ed.), Survey methods: Applications to longitudinal studies, to health, to electoral studies and to studies in developing countries (pp. 334-339). Paris: Dunod.<\/p>\n

Stegenga, J., Bell, E., & Matlow, A. (2002). The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infection Control & Hospital Epidemiology, 23(3), 133-136.
\n\u00a9 Improvement Science Research Network, 2012<\/p>\n

The ISRN\u00a0published this as received and with permission from the author(s).[\/vc_column_text][\/vc_column][vc_column width=”1\/3″]