09.12.2005

Patients Undergoing Cancer Surgery are Safer in Hospitals With Higher RN-to-Patient Ratios

New Study Finds a 50 Percent Cut in Patient Mortality/Complications in Better-staffed Hospitals

Better Ratios Allow Community Hospitals to Provide Quality of Care on Par with Larger Urban Medical Centers

CANTON, Mass.—Patients undergoing common types of cancer surgery are safer in hospitals with higher RN-to-patient ratios according to a new study published in this month’s issue of the Journal Cancer, the official medical journal of the American Cancer Society. In addition, the study found smaller community hospitals that implement high RN-to-patient ratios can provide a level of safety and quality of care for cancer patients on a par with much larger urban medical centers that specialize in performing similar types of surgery.

“High registered nurse-to-patient ratios were found to reduce the mortality rate by greater than 50 percent,” according to Linda Elting, the study’s author and researcher at the University of Texas M.D. Anderson Cancer Center in Houston. “The current study findings point to measures for improvement in the quality of care at the hospital level. The association between high registered nurse staffing and low perioperative mortality suggests the importance of recruiting and retaining an adequate number of registered nurses in hospitals in which moderate-risk cancer procedures are performed.”

According to Karen Higgins, RN, president of the Massachusetts Nurses Association, “This new study strongly validates our position in this debate and argues for passage of legislation to regulate a safe standard of care for all Massachusetts patients in the form of RN-to-patient ratios.” It is the latest in a long line of scientific research that clearly demonstrates the value of regulating RN-to-patient ratios in hospitals as a life saving measure, and in this study, it clearly demonstrates the benefits of doing so for smaller community hospitals.”

The study examined a number of post-operative complications and mortality rates for more than 1,300 patients undergoing cystectomy, a common, moderate risk surgery to treat bladder cancer between 1999 and 2001 in all Texas hospitals. The authors were particularly interested in comparing patient outcomes for patients undergoing surgery in hospitals with different characteristics. They found, as has been proven in a number of studies, that patients undergoing moderate risk cancer surgery have fewer complications and better survival rates in hospitals that perform a high volume of those types of surgery as compared to patients treated in hospitals that perform a low volume.

Ratios Help Smaller Community Hospitals Compete on Quality

The study expanded on previous research by analyzing the link between nurses’ patient loads and outcomes for patients. The key finding was that having a good RN-to-patient ratio at a low volume hospital resulted in patient outcomes that were equivalent to those at high volume hospitals. The author argues that rural and community hospitals would be well advised to have better ratios to improve quality of care and make surgery at that hospital a more attractive option.

“This study has broad implications for our community hospital system which struggles with the problem of keeping patients in their community from traveling miles away to major medical centers,” said Higgins. “For the health care system, this would take stress off the major medical centers, limit overcrowding, and boost the financial health of those community hospitals, while at the same time, improving the outcomes for all patients.”

“The practical results of the current study add to the growing body of literature suggesting that referral to a high-volume center is a prudent approach for patients who live locally. However, we argue that this most likely is neither feasible nor desirable for the large number of patients who are far removed from specialty centers. In many parts of the U.S., high-volume hospitals are too few and too far away to make widespread referral. Among patients who do not have access to high-volume hospitals, treatment in a local hospital with a high nurse-to-patient ratio may confer a similar benefit,” the study concluded.

The new study appears at a time when the Massachusetts legislature is debating competing versions of legislation to improve patient safety in Massachusetts hospitals. The Massachusetts Nurses Association, along with a coalition of 91 leading health care and consumer groups is promoting H. 2663, legislation that would establish safe, minimum RN-to-patient ratios in Massachusetts acute care hospitals. The Massachusetts Hospital Association is proposing a bill that allows hospitals to continue to set their own staffing levels and report those levels to the Department of Public Health.

A hearing on the two nursing bills was held in July before the Joint Committee on Public Health, which is considering both.