This study determined whether the number of hours of care provided by RNs was related to mortality and complications in hospitalized children. Administrative data (1996-2001) were used to examine discharges of 3.65 million pediatric patients in 286 general and children's hospitals in California. A greater number of resource-adjusted hours of care provided by RNs was related to significantly reduced occurrences of postoperative pulmonary complications, postoperative pneumonia, and postoperative septicemia; the positive impact of increases in nurse staffing was of greater magnitude at institutions providing fewer resource-adjusted hours of RN care. There was also evidence of an impact of increases in nurse staffing on urinary tract infections, but it was statistically significant only for institutions with higher resource-adjusted hours of RN care. There was no statistically significant relationship between RN staffing and mortality. More hours of care provided by RNs was associated with improved quality of care for hospitalized pediatric patients.
Agency for Healthcare Research and Quality. ( 2006). Measures of pediatric health care quality based on hospital administrative data: The pediatric quality indicators. Retrieved July, 2, 2006, from http://www.qualityindicators.ahrq.gov/downloads/pdi/pdi_measures_v30.pdf
2.
Archibald, L., Manning, M., Bell, L., Banerjee, S., & Jarvis, W. (1997). Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatric Infectious Disease Journal, 16, 1045-1048.
3.
Cameron, A., & Trivedi, P. (1998). Regression analysis of count data. New York: Cambridge University Press.
4.
Gonnella, J.S., Hornbrook, M.C., & Louis, D.Z. (1984). Staging of disease. A case-mix measurement. Journal of theAmerican Medical Association, 251, 637-644.
5.
Hicks, R., Becker, S., & Cousins, D. (2006). Harmful medication errors in children: A 5-year analysis of data from the USP's MED-MARX program. Journal of Pediatric Nursing, 21, 290-298.
6.
Iezzoni, L. (2003). Risk adjustment for measuring health care outcomes . Chicago: Health Administration Press.
7.
Kanter, D.E., Turenne, W., & Slonim, A.D. (2004). Hospital-reported medical errors in premature neonates. Pediatric Critical Care ofMedicine, 5, 119-123.
8.
Kaushal, R., Bates, D.W., Landrigan, C., McKenna, K.J., Clapp, M.D., Federico, F., et al. (2001). Medication errors and adverse drug events in pediatric inpatients. Journal of theAmerican Medical Association , 285, 2114-2120.
9.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system . Washington, DC: National Academy Press.
Kovner, C., & Gergen, P.J. (1998). Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image: Journal of Nursing Scholarship , 30, 315-321.
12.
Kovner, C., Jones, C., Zhan, C., Gergen, P.J., & Basu, J. (2002). Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of U.S. hospitals, 1990-1996 . Health Services Research, 37, 611-629.
13.
Lawthers, A.G., McCarthy, E.P., Davis, R.B., Peterson, L.E., Palmer, R.H., & Iezzoni, L.I. (2000). Identification of in-hospital complications from claims data. Is it valid? Medical Care, 38, 785-795.
14.
Mangione-Smith, R., & McGlynn, E. (1998). Assessing the quality of healthcare provided to children. Health Services Research, 33, 1059-1090.
15.
Marcin, J., Rutan, E., Rapetti, P., Brown, J., Rahnamayi, R., & Pretzlaff, R. (2005). Nurse staffing and unplanned extubation in the pediatric intensive care unit. Pediatric Critical Care Medicine , 6, 254-257.
16.
Mark, B.A., Harless, D.W., McCue, M., & Xu, Y. (2004). A longitudinal examination of hospital registered nurse staffing and quality of care. Health Services Research , 39, 279-300.
17.
Miller, M.R., Elixhauser, A., & Zhan, C. (2003). Patient safety events during pediatric hospitalizations . Pediatrics, 111, 1358-1366.
18.
Miller, M.R., & Zhan, C. (2004). Pediatric patient safety in hospitals: A national picture in 2000. Pediatrics, 113, 1741-1746.
19.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine , 346, 1715-1722.
20.
Phibbs, C.S., Bronstein, J.M., Buxton, E., & Phibbs, R.H. (1996). The effects of patient volume and level of care at the hospital of birth on neonatal mortality. Journal of the American Medical Association,276, 1054-1059.
21.
Raju, T.N., Kecskes, S., Thornton, J.P., Perry, M., & Feldman, S. (1989). Medication errors in neonatal and paediatric intensive-care units. Lancet, 2, 374-376.
22.
Sedman, A., Harris, M., Schulz, K., Schwalenstocker, E., Remus, D., Scanlon, M., et al. (2005). Relevance of the Agency for Healthcare Research and Quality patient safety indicators for children's hospitals. Pediatrics, 115, 135-145.
23.
Slonim, A.D., LaFleur, B.J., Ahmed, W., & Joseph, J.G. (2003). Hospital-reported medical errors in children. Pediatrics, 111, 617-621.
24.
Stegenga, J., Bell, E., & Matlow, A. (2002). The role of nurse under-staffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infection Control and Hospital Epidemiology, 23, 133-136.
25.
Thomson-Medstat. (2002). Medstat disease staging software (Version 4.13). Reference guide. Ann Arbor, MI: The Medstat Group.
