Magnet Hospitals Show Lower Mortality for Surgery Patients

Larry Hand

October 30, 2012

Magnet hospitals had 14% lower odds of mortality in surgery patients compared with non-Magnet hospitals in a 4-state area during a 2-year period, according to a study published online October 7 in Medical Care. However, the better patient outcomes are attributable to more than just better nursing care.

The American Nurses Credentialing Center's Magnet Recognition Program was established in the 1990s. Today, almost 400 hospitals are recognized as "Magnet" hospitals — meaning they have been identified as good places for nurses to work — representing about 8% of hospitals nationwide. Many of the Magnet hospitals in this study are large, nonprofit, teaching, and high-tech hospitals.

Matthew D. McHugh, PhD, JD, from the Robert Wood Johnson Foundation Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, and colleagues analyzed patient, nurse, and hospital data at 56 Magnet hospitals and 508 non-Magnet hospitals in California, Florida, Pennsylvania, and New Jersey for 2006 to 2007. In total, the hospitals account for more than 20% of annual US hospitalizations, and their characteristics are similar to those of hospitals nationally.

The study was a follow-up to a 1994 Medical Care study that was the first to report better patient outcomes for Magnet hospitals.

In the current study, the researchers found that Magnet hospitals had significantly better work environments (composite score, 2.86 in Magnet hospitals vs 2.66 in non-Magnet hospitals; P < .001), significantly higher proportions of nurses with a bachelor's degree (0.46 vs 0.39; P < .001), higher proportions of certified specialty nurses (0.40 vs 0.36; P < .03), and lower proportions of supplemental nurses (0.39 vs 0.51; P < .03). In Magnet hospitals, nurse case loads were 4.82 patients compared with 5.03 patients in non-Magnet hospitals (P = .056).

The researchers also found that the composite nursing measure, a score that indicates whether a Magnet hospital is such because of its nursing characteristics, differed significantly between Magnet and non-Magnet hospitals (0.24 vs 0.08, respectively; P < .001).

For surgical patient mortality, 1.5% of patients died within 30 days in Magnet hospitals compared with 1.8% in non-Magnet hospitals (P < .001). Failure-to-rescue mortality amounted to 3.8% of Magnet patients and 4.6% of non-Magnet patients (P < .001).

The researchers used logistic regression modelling to develop 3 models to estimate the effect of Magnet status, the effect of the composite measure of nursing, and the combined effect of Magnet status and the composite measure of nursing.

In model 1, they found that the odds ratios for Magnet-only status were 0.80 (95% confidence interval [CI], 0.71 - 0.89) for 30-day mortality and 0.81 (95% CI, 0.72 - 0.91) for failure-to-rescue mortality. Odds ratios for composite nursing measure–only (not including Magnet status) were significantly lower, at 0.50 (95% CI, 0.38 - 0.67; P < .001) for 30-day mortality and 0.48 (95% CI, 0.37 - 0.63; P < .001).

In the combined model, the researchers found that the composite nursing measure was significantly associated with mortality (odds ratio, 0.62; 95% CI, 0.44 - 0.87, P = .005), and they found that the Magnet status was still significant, but to a lesser degree than in model 1 (odds ratio, 0.86; 95% CI, 0.76 - 0.98; P = .02). They found similar results for failure-to-rescue mortality.

"[W]e find that surgical patients cared for in Magnet hospitals have significantly lower odds of mortality and failure-to-rescue than those cared for in non-Magnet hospitals," the researchers write. "Controlling for differences in nursing, hospital, and patient characteristics, surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower odds of failure-to-rescue compared with patients cared for in non-Magnet hospitals."

In addition to measured nursing characteristics, a residual effect of Magnet hospitals could mean an institution is highly committed to excellence or willing to explore organizational innovation. Magnet recognition itself could also be "a marker of preexisting quality, pursued by hospitals that had better care outcomes before Magnet recognition," the researchers write.

This research was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars program, National Institute of Nursing Research, and the American Nurses Foundation. The authors have disclosed no relevant financial relationships.

Med Care. Published online October 7, 2012. Abstract