The effect of critical care nursing and organizational characteristics on pediatric cardiac surgery mortality in the United States.
OBJECTIVE
This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States.


BACKGROUND
Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality.


METHODS
Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years.


RESULTS
The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality.


CONCLUSIONS
These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality.
Author Affiliations: Vice President, Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children's Hospital, and Assistant Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts (Dr Hickey); Research Associate in Cardiology, Boston Children's Hospital, and Associate Professor in Pediatrics, Harvard Medical School, Boston, Massachusetts (Dr Gauvreau); Ellen and Robert Kapito Professor in Nursing Science, School of Nursing, University of Pennsylvania, Philadelphia, and Nurse Scientist, Cardiovascular and Critical Care Services, Boston Children's Hospital, Massachusetts (Dr Curley); Director of Nursing Research, Cardiovascular Program Department of Nursing Patient Services, Boston Children's Hospital, Massachusetts (Dr Connor).
Patricia A
PA
Hickey
Kimberlee
K
Gauvreau
Martha A Q
MA
Curley
Jean A
JA
Connor
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data; D064648:Critical Care Nursing / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D015279:Organizational Culture; D014481:United States