Olga Yakusheva1, Deena K Costa, Marianne Weiss. 1. *School of Nursing and School of Public Health †School of Nursing, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI ‡School of Nursing, Marquette University, Milwaukee, WI.
Abstract
BACKGROUND: Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES: This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hospitalization. RESEARCH DESIGN: Retrospective longitudinal analysis of electronic health records (EHR). Average point-in-time discontinuity was estimated from time of admission to discharge and compared with theoretical predictions for optimal continuity and random nurse assignment. Mixed-effects models estimated within-patient change in clinical condition following a discontinuity. SUBJECTS: A total of 3892 adult medical-surgical inpatients were admitted to a tertiary academic medical center in the Eastern United States during July 1, 2011 and December 31, 2011. MEASURES: Exposure: discontinuity of nursing care was measured at each nurse assessment entry into a patient's EHR as assignment of the patient to a nurse with no prior assignment to that patient. OUTCOME: patient's clinical condition score (Rothman Index) continuously tracked in the EHR. RESULTS: Discontinuity declined from nearly 100% in the first 24 hours to 70% at 36 hours, and to 50% by the 10th postadmission day. Discontinuity was higher than predicted for optimal continuity, but not random. Each instance of discontinuity lead to a 0.12-0.23 point decline in the Rothman Index score, with more pronounced effects for older and high-mortality risk patients. CONCLUSIONS: Discontinuity in acute care nurse assignments was high and negatively impacted patient clinical condition. Improved continuity of provider-patient assignment should be advocated to improve patient outcomes in acute care.
BACKGROUND: Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES: This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hospitalization. RESEARCH DESIGN: Retrospective longitudinal analysis of electronic health records (EHR). Average point-in-time discontinuity was estimated from time of admission to discharge and compared with theoretical predictions for optimal continuity and random nurse assignment. Mixed-effects models estimated within-patient change in clinical condition following a discontinuity. SUBJECTS: A total of 3892 adult medical-surgical inpatients were admitted to a tertiary academic medical center in the Eastern United States during July 1, 2011 and December 31, 2011. MEASURES: Exposure: discontinuity of nursing care was measured at each nurse assessment entry into a patient's EHR as assignment of the patient to a nurse with no prior assignment to that patient. OUTCOME: patient's clinical condition score (Rothman Index) continuously tracked in the EHR. RESULTS: Discontinuity declined from nearly 100% in the first 24 hours to 70% at 36 hours, and to 50% by the 10th postadmission day. Discontinuity was higher than predicted for optimal continuity, but not random. Each instance of discontinuity lead to a 0.12-0.23 point decline in the Rothman Index score, with more pronounced effects for older and high-mortality risk patients. CONCLUSIONS: Discontinuity in acute care nurse assignments was high and negatively impacted patient clinical condition. Improved continuity of provider-patient assignment should be advocated to improve patient outcomes in acute care.
Authors: Olga Yakusheva; Marianne E Weiss; Kathleen L Bobay; Linda Costa; Ronda G Hughes; Morris Hamilton; James Bang; Peter I Buerhaus Journal: Med Care Date: 2019-09 Impact factor: 2.983