Nursing Quality Affects Neonatal ICU Outcomes

Very low birth weight (VLBW) infants born in hospitals awarded recognition for nursing excellence fared slightly better than those born in hospitals without this rating, according to a new study.

Researchers at the University of Pennsylvania (Philadelphia, USA) conducted a cohort study involving 72,235 VLBW infants weighing 501-1,500 grams, born in 558 neonatal intensive care units (NICUs) between January 1, 2007, and December 31, 2008.

Hospital recognition for nursing excellence (RNE) was determined from the American Nurses Credentialing Center. The main outcome measures were seven-day, 28-day, and hospital stay mortality; nosocomial infection occurring more than three days after birth; and severe intraventricular hemorrhage.

The results showed that the outcome rate for 7-day mortality was 7% in RNE hospitals, compared to 7.4% in non-RNE hospitals. The 28-day mortality was 10% in RNE hospitals and 10.5% in non-RNE hospitals. Hospital stay mortality was 12.4% in RNE hospitals and 13.1% in non-RNE hospitals. Severe intraventricular hemorrhage was 7.2% in RNE hospitals and 7.8% in non-RNE hospitals. Infection was 16.7% in RNE hospitals and 18.3% in non-RNE hospitals. Compared with RNE hospitals, the adjusted absolute decrease in risk of outcomes in RNE hospitals ranged from 0.9% to 2.1%, with all five outcomes jointly significant. The study was published in the April 25, 2012, issue of the Journal of the American Medical Association (JAMA).

“Among Very low birth weight infants born in RNE hospitals compared with non-RNE hospitals, there was a significantly lower risk-adjusted rate of 7-day mortality, nosocomial infection, and severe intraventricular hemorrhage, but not of 28-day mortality or hospital stay mortality,” concluded lead author Eileen Lake, PhD, RN, and colleagues. “Perhaps RNE hospitals have a broad, long-standing commitment to quality care that is reflected in other aspects of care, such as excellent physician care, respiratory care, or infection control, that are not directly related to RNE but that may independently contribute to better outcomes for VLBW infants. Thus, RNE status may serve as a marker for an institution-wide commitment to optimizing outcomes.”

The RNE designation is awarded when nursing care achieves exemplary practice or leadership in five areas - transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. In order to achieve RNE, a hospital must conduct a self-evaluation to identify areas of need, implement adaptations as needed, and then be evaluated by outsiders. Only 7% of hospitals in the United States overall currently carry the RNE rating, as do 20% of centers with NICUs.

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