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.
journal_name
Med Carejournal_title
Medical careauthors
Yakusheva O,Costa DK,Weiss Mdoi
10.1097/MLR.0000000000000670subject
Has Abstractpub_date
2017-04-01 00:00:00pages
421-427issue
4eissn
0025-7079issn
1537-1948journal_volume
55pub_type
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