Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.
Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder and 4 others
PMID 40127111WHAT IT FOUND
Most vulnerable patients had 25.8% 30-day inpatient mortality versus 19.8% for least vulnerable, and were less often admitted to hospitals with lower patient-to-nurse ratios and better work environments.
This was an association, not proof.
Key findings
01Mortality within 30 days of admission was 19.8% in the lowest social vulnerability quartile and 25.8% in the highest quartile.
02High-performing hospitals had an average inpatient mortality rate of 16.2%, compared with 31.5% in low-performing hospitals, and low-performing hospitals had higher medical-surgical patient-to-nurse ratios (6.1 vs 5.4) and lower nurse work environment scores (2.58 vs 2.78).
03Patients in the highest social vulnerability quartile were admitted to top-performing hospital tertiles less often (37.8%) than patients in the lowest quartile (50.5%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional and observational, so it cannot show that better nurse staffing or work environments caused lower mortality. It included only Medicare beneficiaries in New York and Illinois in 2020, so it may not apply to younger patients, other states, or later phases of the pandemic. The benchmarking model could not account for all factors that affect death, and the authors note that racism, discrimination, segregation, and changing treatments may have influenced hospital performance. Social vulnerability was assigned from census-tract data, not individual patient circumstances. Nurse work environment and staffing were measured from a survey collected before the pandemic, not during the 2020 admissions.
Declared interests
The supplied article text does not report author conflicts or a funding declaration. The metadata lists Research Support, N.I.H., Extramural.
The easy way to misread this
Do not read the estimated 1,468 fewer deaths or the better nurse staffing in high-performing hospitals as proof that changing staffing alone would reduce mortality. This was a cross-sectional hospital analysis, and the authors say unobserved factors, racism, discrimination, segregation, and evolving treatments may have influenced performance.