Abstract 16381: Critical Care Nursing Experience and Education are Associated With Outcomes Following Pediatric Cardiac Surgery: An Analysis of the STS Congenital Heart Surgery Database
Background: Little is known about the relationship between nursing characteristics and pediatric cardiac surgery outcomes. We evaluated the association of critical care nursing education and experience with outcomes in a large multi-center cohort of children undergoing cardiac surgery.
Methods: Data from Children’s Hospital Association members participating in a nursing survey were linked to clinical data from the STS Congenital Database for children (0-18 yrs) undergoing cardiac surgery (2010-11). Level of nursing education and years of clinical experience were assessed for nurses in the unit caring for post-operative cardiac patients. Association of these variables with outcome was examined using multivariable logistic regression models accounting for within-center clustering and differences in case mix and patient characteristics across hospitals. Outcomes included in-hospital mortality, complication rate, and failure-to-rescue rate (FTR; mortality rate in those with a complication).
Results: Overall, 15,463 patients (29 hospitals) were included. The in-hospital mortality rate was 2.8%, post-operative complications occurred in 42.4%, and the FTR rate was 6.4%. In adjusted analysis, units with a higher proportion of nurses with a Bachelor of Science in nursing (BSN) education had lower complication rates (OR for 10% increase = 0.85, 95% CI 0.76-0.96, p<0.01). Units with a higher proportion of nurses with >2 years of experience had lower mortality rates (OR for 10% increase = 0.91, 95% CI 0.84-0.99, p=0.025). Results were similar when center volume was added to the models, suggesting that the relationship of these nursing characteristics with outcome is independent of volume. Neither nursing variable was associated with FTR in our analysis.
Conclusions: This study demonstrates that higher levels of critical care nursing education are associated with fewer complications following pediatric cardiac surgery, and confirms the results of previous analyses demonstrating the association of nursing education and experience with lower mortality. These data may help to inform decisions about nursing resource allocation and retention strategies to optimize outcomes for this complex population.
Author Disclosures: S.K. Pasquali: None. J.W. Gaynor: None. X. He: None. K.D. Hill: None. J.A. Connor: None. K. Gauvreau: None. M.L. Jacobs: None. J.P. Jacobs: None. J.C. Hirsch-Romano: None.
- © 2014 by American Heart Association, Inc.