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Evaluation of paediatric nursing-sensitive outcomes in an Australian population using linked administrative hospital

Sally Wilson1, Alexandra P Bremner, Yvonne Hauck

  • 1School of Population Health, The University of Western Australia, 35 Stirling Hwy, Perth 6009, Western Australia. sally.wilson@curtin.edu.au.

BMC Health Services Research
|October 10, 2013
PubMed

Insights

This study identified key pediatric nursing-sensitive outcomes from hospital data. Certain outcomes like GI infections and LRTI pose higher risks for younger children, requiring age-adjusted comparisons for quality monitoring.

Area of Science:

  • Pediatric healthcare quality
  • Nursing-sensitive outcomes research
  • Health services research

Background:

  • Existing research on nursing-sensitive outcomes primarily focuses on adult hospital populations.
  • This study developed and validated algorithms for 13 pediatric nursing-sensitive outcomes.
  • The clinical utility of these pediatric outcomes was examined using administrative data.

Purpose of the Study:

  • To determine the incidence rates of pediatric nursing-sensitive outcomes in a Western Australian hospital.
  • To identify sociodemographic and clinical factors associated with increased risk of these outcomes in hospitalized children.
  • To assess the potential utility of these outcomes for quality monitoring in pediatric care.

Main Methods:

  • A retrospective cohort study analyzed linked administrative data for children (≤18 years) admitted to a tertiary pediatric hospital in Perth (1999-2009).
  • Rates per 1,000 separations and 10,000 patient days were calculated for 13 defined nursing-sensitive outcomes.
  • Poisson multiple regression models were used to identify risk factors and estimate rate ratios (RR) with 95% confidence intervals (CI).

Main Results:

  • Analysis included 129,719 hospital separations, with rates varying from 0.5/1,000 (pressure ulcer) to 14.0/1,000 (gastrointestinal infections).
  • Age significantly impacted risk: toddlers had higher GI infection risk (RR 9.89), infants higher LRTI risk (RR 7.74), while neonates had lower sepsis and physiologic/metabolic derangement risks.
  • Emergency admissions showed a significantly higher risk of surgical wound infection (RR 7.78) compared to elective admissions.

Conclusions:

  • Seven of the 13 nursing-sensitive outcomes (LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis, postoperative cardiopulmonary complications) occurred frequently enough for quality monitoring.
  • These outcomes can be valuable tools for quality improvement initiatives and benchmarking.
  • Equitable comparisons necessitate adjusting or stratifying data by patient age and admission type.
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