Abstract
BackgroundThere is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions.MethodsUsing algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients.ResultsLinked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per 10,000 patient days) respectively, and an 84% increase in the proportion of surgical wound infection (from 5.7 to 10.4 per 1,000 separations).ConclusionsAlgorithms for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates.
Highlights
There is increasing interest in the contribution of the quality of nursing care to patient outcomes
Needleman et al.’s development of nursing-sensitive outcomes was guided by three criteria: (1) that nursingsensitive outcomes be conceptually related to nursing care, (2) that outcomes be ‘codable’ from hospital patient discharge abstracts, and (3) that the outcomes occur in inpatient acute care settings with high enough frequency and variation to allow for statistical analysis [9] [p 37]
The present study focused on these three nursingsensitive outcomes and aimed to determine whether Needleman et al.’s algorithms, or variations of them, were useful in paediatric populations
Summary
There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Based on the literature and expert clinical opinion, Needleman et al identified 14 potential nursing-sensitive outcomes that could be measured using routinely collected administrative health data. These included: pressure ulcers, deep vein thrombosis and pulmonary embolism, pneumonia, urinary tract infection, central nervous system complications, shock or cardiac arrest, upper gastrointestinal bleed, pulmonary failure, physiologic/metabolic derangement, surgical wound infection, mortality, failure to rescue and length of stay [9]. Administrative health data are electronic records collected for administrative purposes that include patients’ hospital discharge summaries These were determined to be the best source for constructing nursing-sensitive outcomes, because they contain diagnoses and procedures coded according to the International Classification of Diseases (ICD) and contain patient level variables such as age, sex, country of birth, and health insurance status in a relatively uniform format [9]. Needleman et al.’s development of nursing-sensitive outcomes was guided by three criteria: (1) that nursingsensitive outcomes be conceptually related to nursing care, (2) that outcomes be ‘codable’ from hospital patient discharge (separation) abstracts, and (3) that the outcomes occur in inpatient acute care settings with high enough frequency and variation to allow for statistical analysis [9] [p 37]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
