Higher Nurse Staffing Ratios Also Reduce Children's Hospital Readmissions

A study published in the online journal BMJ Quality and Safety in Health Care finds that higher nurse-to-patient ratios are directly correlated with reduced hospital readmissions for children with common medical and surgical conditions.

The research team was led by Heather Tubb-Cooley of Cincinnati Children's Hospital Medical Center, and included Douglas Sloane and  Linda Aiken, who have conducted research into several aspects of nursing care and nurse staffing.

The study found that an increase of just one patient in a hospital's average nurse staffing ratio increased the likelihood of readmission for medical pediatric within 15 - 30 days by 11 percent, and for surgical patients by 48 percent. Researchers examined outcomes of more than 90,000 children in 225 hospitals.

A recent post on the Human Capital blog by Nancy Ryan-Wenger addresses the importance of ascertaining children's perceptions of the care they receive in the hospital. Ryan-Wenger's study to elicit children's perceptions of nursing care was funded by INQRI. She has gone on to develop a checklist that Nationwide Children's Hospital now uses in daily interviews with pediatric patients and for nurses' daily evaluations.

It is National Nurse Week!

With Sunday, May 6th kicking off National Nurses Week, we believe it is appropriate to highlight news stories that celebrate this annual week of recognition.

On Sunday, Brittany Tyner, reporting for local CBS affiliate, WLFI 18, highlighted an annual reunion that allows for children who were once cared for in Indiana University Health Arnett's neonatal intensive care unit to meet the caregivers that greatly contributed to their childhood well-being. The annual reunion also allows for the parents of children who were cared for in the NICU to continue to express their gratitude to the nurses and physicians that helped their children start life out on the right foot.

Click here to read more about this great tradition.

Pediatric Advance Care Discussions Difficult for Nurses and Physicians

Yesterday, Larry Hand, of medscape.com, detailed a newly published study in this month's Pediatrics that surveyed physicians and nurses at intensive care units (ICUs) and oncology wards at Children's Hospital Boston and Dana-Farber Cancer Institute in Massachusetts to identify barriers to advance care discussion and planning for children. The survey identified the top 3 barriers for ACD discussions regarding children: unrealistic parent expectations, differences between the way physicians and parents understand a prognosis, and lack of parent readiness to have the discussion.

Click here to read Mr. Hand's summary of the article.

Click here to read the study as it appears in Pediatrics.

Quality of Pediatric Nursing Care from the Children's Perspective

Part 1: Dr. Nancy Ryan-Wenger (Nationwide Children's Hospital) presents the study, "Quality of Pediatric Nursing Care from the Children's Perspective" at INQRI's 4th Annual Meeting.



Part 2: Dr. Bill Gardner (Nationwide Children's Hospital) presents findings and the researchers answer questions. Moderated by INQRI National Advisory Committee member Randall Krakauer, MD.



Project Description: This interdisciplinary research team identified hospitalized children's perceptions of the linkages between the quality of nursing care and outcomes. This study identified the nursing care processes and outcomes that matter most to children during their hospitalization, and estimated the extent to which disparities exist in the quality of their care and outcomes.

Children's View on Quality Should be Considered

Early in his term President Barack Obama signed into law the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA promised a “new day for children’s health care quality” and launched a new coordinated effort from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) to implement its quality provisions.

Today, AHRQ’s National Advisory Council for Healthcare Research and CMS’s Quality Subcommittee on Quality Measures for Children’s Healthcare in Medicaid and Children’s Health Insurance Programs (CHIP) are holding a two-day meeting (July 22-23) on healthcare quality and research on issues related to pediatric care. This inaugural meeting is an exciting step forward in the implementation of CHIPRA and pediatric quality measures, an issue that two INQRI grantees have researched extensively.

Nearly half of the 7.6 million children hospitalized every year in the United States are over age 6, yet no one ever systematically asks these children about their hospital experiences or the quality of care they have received. Instead they turn to their parents to answer for them.

Columbus Children’s Hospital researchers Nancy Ryan-Wenger and William Gardner say too often children are the “silent consumers of care.” Their INQRI research of hospitalized children has shown that seeking answers from parents is not an accurate measure of children’s perceptions of their care. In fact, children prioritize an entirely different set of factors when rating their hospital experience. The graph below shows that while only about 10% of parents view “check on me often” as an important factor in the care of their children, children see this as a very important measure of their care. And, the list goes on from there.

Through their research, Ryan-Wenger and Gardner are hoping to improve the reliability of tools to measure children’s health care, an effort that has great implications for changing nursing practice and improving care. Why are children’s perceptions important? Early experiences with medical care can greatly impact future decision-making about seeking care. It can even influence future career decisions in a time when bringing new nurses and doctors into the system is essential and becoming increasingly important to the success of American healthcare.

Ryan-Wenger and Gardner recommend both adding a “quality of care from the hospitalized children’s perspective” component to existing nursing sensitive indicators and working to develop and implement a standard, reliable measure of a “children’s hospital experience scale.” They provide a sample concept, reproduced below.

As AHRQ and CMS meet with stakeholder groups this week on pediatric healthcare quality measures, they must acknowledge the difference between parents’ and children’s views of care and take that into account. There are ubiquitous surveys seeking patient views on hospital care but there are no surveys that ask children to answer directly. Ryan-Wenger and Gardner say this has to change because children’s opinions matter.

For more on Ryan-Wenger and Gardner’s study, please click here.