Using publicly reported nursing-sensitive screening indicators to measure hospital performance: The Netherlands experience in 2011

Background Deliberate screening allows detection of health risks that are otherwise not noticeable and allows expedient intervention to minimize complications and optimize outcomes, especially during critical events like hospitalization. Little research has evaluated the usefulness of screening performance and outcome indicators as measures to differentiate nursing quality, although policymakers are using them to benchmark hospitals. Objectives The aims of this study were to examine hospital performance based on nursing-sensitive screening indicators and to assess associations with hospital characteristics and nursing-sensitive outcomes for patients. Methods A secondary use of nursing-sensitive data from the Dutch Health Care Inspectorate was performed, including the mandatory screening and outcome indicators related to delirium, malnutrition, pain and pressure ulcers. The sample consisted of all 93 hospitals in the Netherlands in 2011. High- and low-performing hospitals were determined based on the overall proportion of screened patients. Descriptive statistics and analysis of variance were used to examine screening performances in relation to hospital characteristics and nursing-sensitive outcomes. Results Over all hospitals, the average screening rates ranged from 59% (delirium) to 94% (pain). Organizational characteristics were not different in high- and low-performing hospitals. The hospitals with the best overall screening performances had significantly better results regarding protein intake within malnourished patients (p < .01). For mortality, marginal significant effects did not remain after controlling for organizational structures. No associations were found with prevalence of pressure ulcers and patient self-reported pain scores. Discussion The screening for patient risks is an important nursing task. Our findings suggest that nursing-sensitive screening indicators may be relevant measures for benchmarking nursing quality in hospitals. Time-trend studies are required to support our findings and to further investigate relations with nursing-sensitive outcomes