Nurse Continuity at Discharge and Return to Hospital

Abstract

Background Promoting continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge—which has been associated with fewer readmissions and emergency department visits. The few studies that examined nurse continuity during acute care hospitalizations did not focus on discharge or postdischarge outcomes. Objectives The aim of this research was to examine the association of continuity in nurse assignment to patients prior to hospital discharge with return to hospital (readmission and emergency department or observation visits), including exploration of the mediating pathway through patient readiness for discharge and moderating effects of unit environment and unit nurse characteristics. Methods In a sample of 18,203 adult, medical–surgical patients from 31 Magnet hospitals, a correlational path analysis design was used in a secondary analysis to evaluate the effect of nurse continuity on readmissions and emergency department or observation visits within 30 days after hospital discharge. The mediating pathway through discharge readiness measured by patient self-report and nurse assessments was also assessed. Moderating effects of unit environment and nursing characteristics were examined across quartiles of unit environment (nurse staffing hours per patient day) and unit nurse characteristics (education and experience). Analyses were adjusted for patient characteristics, unit fixed effects, and clustering at the unit level. Results Continuous nurse assignment on the last 2 days of hospitalization was observed in 6,441 (35.4%) patient discharges and was associated with a 0.85 absolute percentage point reduction (7.8% relative reduction) in readmissions. There was no significant association with emergency department or observation visits. Sensitivity analysis revealed a stronger effect in patients with higher Elixhauser Comorbidity Indexes. Readiness for discharge was not a mediator of the effect of continuity on return to hospital. Unit characteristics were not associated with nurse continuity. No moderation effect was evident for unit environment and nurse characteristics. Discussion Continuity of nurse assignment on the last 2 days of hospitalization can reduce readmissions. Staffing for continuity may benefit patients and healthcare systems, with greater benefits for high-comorbidity patients. Nurse continuity prior to hospital discharge should be a priority consideration in assigning acute care nurses to augment readmission reduction efforts.

Clinical nurses' perspectives on discharge practice changes from participating in a translational research study

“…Future studies will need to assess the relative value of the discharging nurse conducting the assessment or another member of the discharge team such as the discharge coordinator or case manager. Of note, we found in another of our studies that patients who had continuity of care from their discharging nurse (when the patient received care from the same nurse on the day of and day before discharge) had lower readmission rates than those without this continuity (Bahr et al., 2020).…”

The Variables of the Readiness for Discharge from Hospital in Patients after Myocardial Infarction

“…In relation to our study, we found an additional characteristic that influenced patient expectations as a component of hospital discharge readiness: it was mostly male patients who had a higher need for more information about their disease and its treatment.The education of patients, carried out duringhospitalization after myocardial infarction, should be planned, monitored and conducted by all members of the therapeutic team in accordance with their competences [ 20 ]. Some studies have indicated that the continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge, which has been associated with fewer readmissions and emergency department visits [ 21 ]. Other research suggests the need for a structured process for discharging a patient from hospital, with tools to help healthcare organizations improve their discharge process and decrease readmission rates [ 22 ].…”

The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study

“…Also, the nurses' experiences were calculated based on the time when the nurse was appointed as a full-time nurse as recorded in the hospital database, which could differ from the actual length of their careers. Finally, there may be other nursing factors that affect patient outcomes, such as education or burnout (Bahr et al, 2020;Jun et al, 2021;Stifter, Yao, Lodhi, et al, 2015), which could not be analysed in the current study. Therefore, in the future, outcome research on nurse continuity should be studied to help address some of these limitations.…”

“…However, low nurse continuity was directly related to a decrease in the clinical status of adult patients admitted to medical‐surgical units, as measured by the Rothman Index (Yakusheva et al, 2017). Furthermore, it has been found that high nurse continuity significantly reduced 30‐day readmission rates (Bahr et al, 2020) and it was a predictor of high levels of patient or caregiver satisfaction (Miedaner et al, 2016; Tonkikh et al, 2020). While studies on nurse continuity have begun to reveal its positive impact on patient outcomes, there is limited research on the application of continuity of care for surgical patients.…”