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Weighing a nurse's value

While patients and their families know that nurses are priceless, a new study puts numbers on the value of nurses to hospitals and the general economy. Researchers culled findings from 28 studies that analyzed the relationship between higher RN staffing and various patient outcomes, including hospital-based mortality, hospital-acquired pneumonia, unplanned extubation, failure to rescue, nosocomial bloodstream infections, and length of stay. They found that adding 133,000 RNs to the acute care hospital workforce would have these benefits:


* saving 5,900 lives/year. The productivity value of total deaths averted is about $1.3 billion/year, or about $9,900 per added RN/year.


* decreasing hospital days by 3.6 million, which would increase national productivity at an estimated $231 million/year.


* saving about $6.1 billion in medical expenses. This translates into a savings of about $46,000 per additional RN/year.



Combining medical savings with increased productivity, researchers estimate an economic value averaging $57,700/year for each of the added 133,000 RNs.

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The average yearly cost for a hospital to employ an RN in 2005, according to the U.S. Bureau of Labor Statistics, was about $85,000 in salary plus benefits. But the researchers emphasize that their findings reflect only part of a nurse's real value. "Only a portion of the services that professional nurses provide can be quantified in pecuniary terms, but the partial estimates of economic value presented illustrate the economic value to society of improved quality of care achieved through higher staffing levels."


The study was sponsored by the American Nurses Association and several other nursing organizations.


Source: Dall TM, Chen YJ, Seifert RF, Maddox PJ, Hogan PF. The economic value of professional nursing. Med Care. 2009;47(1):97-104.



Lax practices put patients at risk

In the last decade, more than 60,000 patients have been asked to get tested for hepatitis B (HBV) and hepatitis C (HCV) because healthcare personnel outside of hospital settings didn't follow basic infection control practices. In a study from the CDC, researchers reviewed healthcare-associated viral hepatitis outbreaks starting in 1998. They identified 33 outbreaks outside of hospital settings in 15 states. The outbreaks occurred in long-term-care facilities (15), outpatient clinics (12), and hemodialysis centers (6). Common factors were reuse of syringes and blood contamination of medications, equipment, and devices. In all, 448 people acquired HBV or HCV infection.


"To protect patients, infection control training, professional oversight, licensing, innovative engineering controls, and public awareness are needed in these healthcare settings," said Dr. Denise Cardo, director of CDC's Division of Healthcare Quality Promotion.


Source: Thompson ND, Perz JF, Moorman AC, et al. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med. 2009;150(1):33-39.



Teaching prevents readmissions

When nurses and pharmacists work with patients to help them learn how to care for themselves after hospital discharge, subsequent hospital readmissions and ED visits drop dramatically. In a study funded by the Agency for Healthcare Research and Quality (AHRQ), researchers developed a program to better educate patients about their posthospital care. Specially prepared nurses helped one group of patients arrange follow-up appointments, confirm drug routines, and understand their diagnoses using a personalized instruction booklet. A pharmacist contacted patients 2 to 4 days after hospital discharge to reinforce the drug plan and answer questions.


One group of 370 patients took part in the specialized discharge program. A second group of 368 patients received usual care.


Thirty days after their hospital discharge, the patients who took part in the discharge program had 30% fewer ED visits and readmissions than the patients who received usual care. In addition:


* 94% of patients in the discharge program left the hospital with a follow-up appointment with their primary care physician, compared with only 35% of patients receiving usual care.


* 91% of those in the discharge program had their discharge information sent to their primary care physician within 24 hours of leaving the hospital.



Nearly two-thirds of patients in the discharge program had at least one problem with their drugs, despite medication review with a pharmacist. In half of those cases, the pharmacist had to take corrective action, such as contacting the prescriber.


The researchers concluded that "a package of discharge services reduced hospital utilization within 30 days of discharge."


Sources: Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150(3):178-187.



You decide if I can't

Research into Alzheimer's disease and other forms of dementia is often hampered because patients aren't competent enough to give informed consent to participate in studies. In a survey of 1,515 people ages 51 and older, researchers investigated whether surrogate consent is an acceptable option.


Survey participants answered questions about one of four surrogate-based research scenarios: lumbar puncture study, drug randomized control study, vaccine study, and gene transfer study. Most (68% to 83%, depending on the scenario) said society should allow family surrogate consent for research studies, and most (55% to 67%) said they'd want to participate in research.


Federal law allows legally authorized adults to give surrogate consent. However, who qualifies as a surrogate is subject to state laws, which are often unclear. Researchers say their findings indicate that older adults support family surrogate consent for dementia research. They conclude, "willingness to allow leeway to future surrogates needs to be studied further for its ethical significance for surrogate-based research policy."


An advisory committee of the U.S. Department of Health and Human Services is also researching the issue.


Source: Kim SYH, Kim HM, Langa KM, et al. Surrogate consent for dementia research: a national survey of older Americans. Neurology. 2009;72(2):149-155.



MRSA infection: Not just skin deep

Rates of methicillin-resistant Staphylococcus aureus (MRSA) in children's ear, nose, and throat infections are increasing dramatically, researchers report. Although the increase in MRSA skin infections in adults and children has been previously documented, this study is the first to report on the prevalence of MRSA in deeper tissues of the head and neck.


Study results are based on nationally representative information from a database that collects lab results from more than 300 hospitals. Researchers found 21,000 pediatric head and neck infections (mostly oropharyngeal/neck infections) caused by S. aureus from 2001 through 2006. The mean patient age was 6.7 years. During the study period, the percentage of cases caused by MRSA more than doubled, from 12% to 28%.


About 60% of the MRSA infections were thought to have been contracted in the community. Forty-six percent of these infections were resistant to clindamycin, one of the drugs often used to treat community-acquired MRSA.


Nationwide disparities in the treatment of various head and neck infections may contribute to regional differences in the prevalence of MRSA infections, researchers write. Because overuse of antibiotics leads to antibiotic resistance, they recommend "judicious" use of antibiotics and better diagnosis and treatment of head and neck infections to reduce the prevalence of MRSA.


Source: Naseri I, Jerris RC, Sobol SE. Nationwide trends in pediatric Staphylococcus aureus head and neck infections. Arch Otolaryngol Head Neck Surg. 2009;135(1):14-16.



Patients line up for care

Outpatient surgery visits made up nearly two-thirds of surgery visits in 2006, compared with only about half of such visits in 1996, according to a new report from the CDC. The number of outpatient surgery visits has also increased to 34.7 million visits in 2006, up from 20.8 million visits in 1996.


Researchers with the CDC collected the data from 142 hospitals and 295 freestanding centers. Federal, military, and Veterans Affairs hospitals were excluded.


Visits to freestanding centers increased dramatically, tripling from 1996 to 2006. In contrast, the rate of outpatient surgery visits to hospitals during the same period was unchanged.


Researchers also found that in 2006:


* Most (57%) outpatient surgery visits were to hospitals versus 43% to freestanding clinics.


* Women accounted for more outpatient surgery visits than men (20 million versus 14.7 million).


* Endoscopies of the large or small intestine and cataract surgery were the most common outpatient procedures.


* Cataract was the leading diagnosis for outpatient surgery, followed by benign and malignant tumor.



The full report, "Ambulatory Surgery in the United States, 2006," is available at



Cleaning products don't clear the air

New-onset asthma is a risk for nurses frequently exposed to hospital disinfectants and other chemicals at work. According to a recent study, nurses who were regularly exposed to cleaning products and disinfectants were 72% more likely than other healthcare professionals to be diagnosed with asthma after starting their job.

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Researchers surveyed a representative sample of 3,650 healthcare professionals who work in Texas. In all, 941 were nurses. Nurses who regularly cleaned medical instruments were 67% more likely to receive an asthma diagnosis after starting their job than other healthcare professionals. In addition, nurses who worked with solvents and glues used in patient-care activities were 51% more likely to report asthmalike symptoms. The researchers concluded that "among nursing professionals, workplace exposure to cleaning products and disinfectants increase the risk of new-onset asthma."


Source: Arif AA, Delclos GL, Serra C. Occupational exposures and asthma among nursing professionals. Occup Environ Med. 2009 Jan 22. [Epub ahead of print]



Treating acute pain with fentanyl

Nurses who recently visited our Web site answered this question:


Is transdermal fentanyl used to treat acute pain in your facility?


Total responses: 489

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Transdermal fentanyl isn't appropriate for treating acute pain. For more information, see "Are Opioids Safe for Your Patient?" on page 40 of this issue. Visit to answer our monthly survey question and view results from other surveys.



Paperless hospitals pay dividends

Patients are safer in facilities where electronic health information technologies have replaced paper forms of gathering, transmitting, and storing information, according to a new study rating clinical information technologies at 41 Texas hospitals. Examining discharge information on 167,233 patients over age 50 admitted between December 1, 2005 and May 30, 2006, researchers rated the following paperless systems: electronic notes, previous treatment records, test results, clinical decision-support systems, and orders for drugs, procedures, and blood tests. Using questionnaires, they asked physicians to determine which electronic systems are in place, if caregivers know how to use them, and if they're used consistently.

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Based on questionnaire results, researchers ranked hospitals according to their use of technology. They found a 15% decrease in the risk of death during hospitalization in hospitals ranked in the top third for automated notes and records. In addition:


* Computerized order entry systems were associated with a 9% decrease in the odds of death from myocardial infarction and a 55% decrease in the odds of death from coronary artery bypass graft surgery.


* Decision-support systems reduced the risk of complications by 21%. (Decision-support systems provide computerized clinical information to help clinicians make treatment choices.)


* Hospitals with the best technology scores had significantly lower patient costs.



Overall, researchers concluded that hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality, and lower costs. They say that computerizing notes and records alone has the potential to save 100,000 lives a year in the United States.


Source: Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes. Arch Intern Med. 2009;169(2):108-114.