Center for Health Outcomes and Policy Research, School of Nursing and
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Hosp Pediatr. 2020 May;10(5):408-414. doi: 10.1542/hpeds.2019-0234. Epub 2020 Apr 6.
The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety.
Using data from a large survey of registered nurses in 330 acute care hospitals, we described nurses' assessments of safety and quality of care in inpatient pediatric settings, including freestanding children's hospitals (FCHs) (n = 21) and general hospitals with pediatric units (n = 309). Multivariate logistic regression models were used to estimate the effects of being a FCH on favorable reports on safety and quality before and after adjusting for hospital-level and nurse characteristics and Magnet status.
Nurses in FCHs were more likely to report favorably on quality and safety after we accounted for hospital-level and individual nurse characteristics; however, adjusting for a hospital's Magnet status rendered associations between FCHs and quality and safety insignificant. Nurses in Magnet hospitals were more likely to report favorably on quality and safety.
Quality and safety of pediatric care remain uneven; however, the organizational attributes of Magnet hospitals explain, in large part, more favorable quality and safety in FCHs compared with pediatric units in general acute care hospitals. Modifiable features of the nurse work environment common to Magnet hospitals hold promise for improving quality and safety of care. Transforming nurse work environments to keep patients safe, as recommended by the National Academy of Medicine 20 years ago, remains an unfinished agenda in pediatric inpatient settings.
本研究旨在从床边工作的护士的角度评估急性儿科环境中的护理质量和安全性，并调查与更有利的质量和安全性相关的医院层面因素。
利用来自对 330 家急性护理医院注册护士的大型调查数据，我们描述了护士对住院儿科环境中护理安全和质量的评估，包括独立儿童医院（FCH）（n=21）和有儿科病房的综合医院（n=309）。使用多变量逻辑回归模型，估计在调整医院层面和护士特征以及磁铁地位后，FCH 对安全性和质量的有利报告的影响。
在考虑到医院层面和个体护士特征后，FCH 中的护士更有可能对质量和安全报告有利；然而，调整医院的磁铁地位使 FCH 与质量和安全之间的关联变得无意义。磁铁医院的护士更有可能对质量和安全报告有利。
儿科护理的质量和安全性仍然不均衡；然而，磁铁医院的组织属性在很大程度上解释了与普通急性护理医院儿科病房相比，FCH 中更有利的质量和安全性。磁铁医院中常见的护士工作环境的可修改特征有望提高护理质量和安全性。正如国家医学院 20 年前所建议的那样，将护士工作环境转变为确保患者安全仍然是儿科住院环境中未完成的议程。
