Patients Negatively Impacted by Discontinuity of Nursing Care During Acute Hospitalization

Med Care. 2017 Apr;55(4):421-427. doi: 10.1097/MLR.0000000000000670.


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.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care*
  • Female
  • Hospitalization*
  • Humans
  • Longitudinal Studies
  • Male
  • Nursing Care*
  • Outcome Assessment, Health Care*
  • Retrospective Studies
  • United States