Nurse resources and surgical outcomes in elderly patients: the role of the safety net

Background: Hip fracture is common in older adults and often requires surgical intervention. Co-management of these patients by geriatricians and orthopedic surgeons has been linked to better outcomes; however, little is known about the allocation of nurse resources and the quality of care in elderly surgical patients. Objective: Examine the allocation of nurse resources in safety net hospitals and non-safety net hospitals and the association between nurse resources and outcomes in elderly patients admitted for surgical repair of hip fracture. Outcomes of interest included in-hospital-mortality, length of stay (LOS) and prolonged length of stay (PLOS). Methods: Retrospective study of all patients 65 years of age and older (n = 10,686) admitted to New Jersey acute care hospitals from January 1, 2010 to December 31, 2011 for surgical repair of hip fracture. Data were from New Jersey Department of Health and Senior Services, New Jersey Hospital Association, State Inpatient Database, American Nurses Credentialing Center and Hospital Alliance of New Jersey. Data were merged and examined using descriptive and inferential statistics. Results: There was no difference in allocation of nurse resources in safety net and non-safety net hospitals. Patients admitted to safety net hospitals had a 44% increase in odds of in-hospital mortality (p = 0.004), 9% increase in LOS (p = 0.06) and 51% increase in odds of PLOS (p = 0.041). Each additional hour of registered nurse care per patient day was associated with a 1% decrease in LOS (p = 0.058) and 9% decrease in the odds of prolonged length of stay (PLOS) (p = 0.012). Magnet accreditation moderated the effect of skill mix and was associated with a 33% decrease in odds of in-hospital mortality (p = 0.059), 67% decrease in LOS (p = 0.000), 99% decrease in odds of PLOS (p = 0.001). Magnet accreditation moderated the effect of registered nurse hours per patient day and was associated with a 53% increase in odds of PLOS (p = 0.001). Conclusion: Hospital safety net status and availability of nurse resources are associated with the quality of care in elderly patients admitted for surgical repair of hip fracture.Ph.D.Includes bibliographical referencesIncludes vitaby Karen Moosv