Fewer patient deaths after surgery in hospitals known for good nursing care

ScienceDaily (Oct. 22, 2012) — Patients treated in magnet hospitals (specially designated for their nursing excellence) had 14 percent lower odds of death than those in non-magnet hospitals in a four-state study of 564 hospitals led by the University of Pennsylvania School of Nursing. The magnet designation, determined by the American Nurses Credentialing Center, recognizes high-quality patient care, high levels of nurse education, and nursing innovation.

"Even controlling for differences in nursing, hospital, and patient characteristics, surgical patients fared better in magnet hospitals," said lead author Dr. Matthew D. McHugh, a public health policy expert at Penn Nursing. "The better outcomes can be attributed in large part to investments in highly qualified and highly educated nurses, and practice environments supportive of high-quality nursing care."

Starting in 1994 with Penn Nursing research, studies on magnet hospitals have shown they yield lower rates of patient death. Ongoing research points to magnet hospitals' having "higher levels of nurse satisfaction, less nurse burnout, lower patient fall rates, and lower mortality among very low birthweight infants," wrote Dr. McHugh and Penn Nursing co-authors in Medical Care. "Magnet hospitals have reputations for being good places for nurses to work. Our findings reinforce that better work environments for nurses are the distinguishing factor between magnet and non-magnet hospitals and are the key to better patient outcomes."

The number of magnet-recognized hospitals in the U.S. is at about 400 -- about 8 percent of hospitals nationally. This study took place in California, Florida, Pennsylvania, and New Jersey -- four of the nation's largest states accounting for more than 20 percent of hospitalizations annually. Nearly 100,000 registered nurses took part in this study.

"The magnet recognition program is not the only means of improving the work environment, but it may provide a replicable blueprint for doing so, to the benefit of nurses and patients," said Dr. McHugh. "Hospitals that have earned magnet status have seen improvement in patient outcomes, suggesting that the process of applying for and retaining magnet recognition, and the networking opportunities that come with magnet recognition, may promote continuing quality improvement and organizational innovation."

Study co-authors are Penn Nursing's Lesly A. Kelly, Herbert L. Smith, Evan S. Wu, Jill M. Vanak, and Linda H. Aiken. Research funding came from the Robert Wood Johnson Foundation, the National Institute of Nursing Research, and the American Nurses Foundation.

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The above story is reprinted from materials provided by University of Pennsylvania School of Nursing.

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Journal Reference:

Matthew D. McHugh, Lesly A. Kelly, Herbert L. Smith, Evan S. Wu, Jill M. Vanak, Linda H. Aiken. Lower Mortality in Magnet Hospitals. Medical Care, 2012; : 1 DOI: 10.1097/MLR.0b013e3182726cc5

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Anesthetic combination provides a more rapid recovery after oral surgery

ScienceDaily (Oct. 11, 2012) — The ideal sedative for oral surgery should make the patient comfortable during the surgery and should wear off quickly enough that the patient can leave the dental chair soon after the procedure. Finding the best plan of anesthetic treatment is essential to the success of dental procedures such as the extraction of wisdom teeth.

A study in the journal Anesthesia Progress compares two drug combinations for use as deep sedation during oral surgery. Patients in a control group received a continuous intravenous infusion of propofol-remifentanil, while those in an experimental group received a continuous intravenous infusion of propofol-ketamine. This was a double-blinded study -- neither patients nor surgeons were aware of which treatment was given.

Oral surgery to extract third molars, also known as wisdom teeth, is a common dental procedure routinely performed with local anesthesia and moderate or deep sedation. This procedure is typically performed in the dental office, not a hospital setting, so there are not extensive facilities and personnel to assist in recovery. Rapid recovery for safe discharge is therefore an important component of dental anesthesia.

In the current study, 37 patients were monitored while sedated for respiratory, heart rate, and blood pressure stability. Emergence from the effects of anesthesia and total recovery time were recorded. Both patients and surgeons were asked to rate their satisfaction with the anesthetic treatments.

Patients who received the ketamine treatment took longer to emerge from the effects of the anesthesia. Their average emergence time was 13.6 minutes compared with 7.1 minutes for patients in the remifentanil group. The recovery period for ketamine patients was 42.9 minutes compared with 24.5 minutes for those who received remifentanil.

Both groups showed similar levels of sedation. However, an increase in heart rate was noted among patients receiving the ketamine treatment. Both patients and surgeons indicated they were very satisfied with either treatment.

While ketamine provides a more cost-effective alternative for dental sedation -- remifentanil is more expensive -- it requires a longer patient recovery time. This study found that the more rapid recovery from the propofol-remifentanil combination makes it a more ideal deep sedative for dental office third molar surgery.

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The above story is reprinted from materials provided by Allen Press Publishing Services, via Newswise.

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Journal Reference:

Kyle J. Kramer, Steven Ganzberg, Simon Prior, Robert G. Rashid. Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery. Anesthesia Progress, 2012; 59 (3): 107 DOI: 10.2344/12-00001.1

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