Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay

Abstract

BACKGROUND:The association of Magnet hospital status with improved surgical outcomes remains an issue of debate. OBJECTIVE: To investigate whether hospitalization in a Magnet hospital is associated with improved outcomes for patients undergoing neurosurgical operations. METHODS: A cohort study was executed using all patients undergoing neurosurgical operations in New York registered in the Statewide Planning and Research Cooperative System database from 2009 to 2013. We examined the association of Magnet status hospitalization after neurosurgical operations with inpatient case fatality and length of stay (LOS). We employed an instrumental variable analysis to simulate a randomized trial. RESULTS: Overall, 190 787 patients underwent neurosurgical operations. Of these, 68 046 (35.7%) were hospitalized in Magnet hospitals, and 122 741 (64.3%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with decreased case fatality (adjusted difference, -0.8%; -95% confidence interval, -0.7% to -0.6%), and LOS (adjusted difference, -1.9; 95% confidence interval, -2.2 to -1.5) in comparison to non-Magnet hospitals. These associations were also observed in propensity score adjusted mixed effects models. These associations persisted in prespecified subgroups of patients undergoing spine surgery, craniotomy for tumor resection, or neurovascular interventions. CONCLUSION:We identified an association of Magnet hospitals with lower case fatality, and shorter LOS in a comprehensive New York State patient cohort undergoing neurosurgical procedures.

Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes

“…Our investigation revealed that Magnet status was associated with a reduction in the effect of nurse burnout on mortality and failure to rescue, but not with length of stay. Previous research has separately observed relationships between Magnet and lower levels of nurse burnout [ 22 ] as well as shorter length of stay [ 64 , 65 ]. Furthermore, some of the differences we observed between our work environment and Magnet findings were likely because Magnet and our measure of the work environment, while conceptually similar, were not perfect substitutes.…”

Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital

“…While the standard LOS for most spinal procedures is about five days [8], only about 40% of patients in our study had a LOS of equal to or less than five days, and patients even with simple lumbar discectomies had a prolonged duration of stay, i.e., >5 days. In a study, Collins et al have shown a duration of stay >8 days in about 30% of cases patients undergoing lumbar procedures, and the median LOS was five days, but that was also because of the associated comorbidities like diabetes, myocardial infarction, renal failure, and congestive heart failure [8][9][10]. Though we did not study all these factors, they cannot account for more than 60% of patients having a prolonged hospital stay, as most of these patients undergoing spinal surgeries were in a good state of health.…”

Testing Hospital Quality Strategic Determinants

“…According to several authors (ANCC, 2017;Chen et al, 2014;Stimpfel et al, 2016), The American Nurses Credentialing Center (ANCC) created another major vehicle for improving hospital quality by implementing the Magnet Recognition Program. Some authors found Magnet Programs implementations somewhat controversial (Lasater et al, 2016;Missios & Bekelis, 2018) for a variety of reasons such as "the program is too short lived or not fully implemented," or "the results are measured in different ways," etc. Nevertheless, the primary reason for implementing these programs is the unquestionable "importance of improving hospital care quality through increased nursing participation in management activities" (Missios & Bekelis, 2018;Park et al, 2016;Stimpfel et al, 2014;The Truth about Nursing, 2016).…”

“…From the organization perspective, hospital quality seems less well recognized. Many authors have addressed the potential factors leading to hospital quality (Missios & Bekelis, 2018;Montgomery et al, 2013;Stimpfel et al, 2016). However, based on their meetings agendas, hospital Governing Board, and top managers have shown a relatively weak interest in hospital quality issues.…”