Mass. hospital website is set to detail nurse staffing levels
Starting today, Massachusetts hospital patients can get detailed information about one of the most important aspects of medical treatment: how many hours a nurse will spend caring for them at their bedside.
A growing body of research shows that the more time nurses spend with patients, the fewer complications patients have and the more likely they are to survive their illness or surgery.
But very little information exists that tells patients what staffing to expect at specific hospitals and on specific units, or even what type of medical workers will take care of them. For example, a patient who has a gastrointestinal illness cannot easily find out which hospitals employ nutritionists in their general medical units.
The Massachusetts Hospital Association today will begin posting on a website, www.patientsfirstma.org, staffing plans for individual hospitals on each of their units. All the hospitals in the state except Jewish Memorial Hospital and Rehabilitation Center in Roxbury, which is changing owners, agreed to participate, association executives said.
''It's a great idea, because there is a very large variation in nurse staffing in hospitals, which is associated with a huge variation in outcomes," said Linda Aiken, a University of Pennsylvania researcher who has published studies on nurse staffing and mortality. ''The public doesn't have any information to make informed decisions on which hospital to go to."
The hospital association's project comes amid pressure from employers and health plans for more public information about the cost and quality of medical care at hospitals and in doctors' offices. Numerous state agencies and health plans post provider report cards online, such as the Department of Public Health's comparison of mortality rates in cardiac surgery programs, and most of these are mandatory. Massachusetts hospitals said they want to create a voluntary program that shows they are committed to openness and advancing patientsafety.
The project also comes at a politically delicate time as the Massachusetts Nurses Association, the statewide union, is pushing legislation that would mandate that hospitals adhere to specific nurse-to-patient ratios, an approach California has adopted.
Hospitals oppose this legislation, saying it does not give them enough flexibility, and union executives said yesterday that the hospital association's website is intended to stall the legislation. The project, union officials said, does not guarantee safety for patients the way mandatory ratios would.
Barbara Cooke, a union board member and a nurse at Brockton Hospital, said a hospital staffing plan ''doesn't guarantee this level of care will be there when you get there. People can't always decide which hospital they're going to go to. Sometimes the ambulance brings you somewhere. There needs to be a standard of care at every hospital in Massachusetts, so when that happens to you, you don't have to worry."
The hospital project is impressive in its detail. For each unit at each hospital, consumers can see the average number of patients per day, the number of registered nurses, licensed practical nurses, and nursing assistants working each shift, and any other staff available on each shift, such as a nutritionist or respiratory therapist. There also is a bottom-line number: the average number of hours a registered nurse or licensed practical nurse spends daily with each patient.
Aiken said this is a good measure of nursing care, and that generally, the more hours nurses spend with a patient, the better. Her research has found that units where nurses care for four or fewer general surgical patients have a 30 percent lower mortality rate than units where nurses care for eight or more patients each.
The Massachusetts Hospital Association's results for individual hospitals, released to the Globe yesterday, show great variation from hospital to hospital. For example, at South Shore Hospital in Weymouth, nurses spend an average of 6 hours per day with each patient on two of its general medical and surgical units. But the hospital also employs assistants to help, one or two per shift.
At Emerson Hospital in Concord, nurses spend an average of 8.25 hours with each patient on North 6, the general medical and surgical unit, but it appears from the website that more care is given by LPNs, who have less training than RNs, than at South Shore.
Hospital association executives said they do not intend for consumers to use the website to make comparisons among hospitals, because the staffing plans do not account for whether certain hospitals have sicker patients, which would require more hours of nursing care, or whether others have more experienced nurses, who would likely be more efficient.
Dr. Donald Berwick, president of the Institute for HealthCare Improvement, a nonprofit organization in Cambridge that promotes patient safety, said he considers other information more important, including whether nurses have technical support that makes their jobs easier, such as electronic medical records.
