Sarah J. Bahr, PhD, MSN, RN, ACNS-BC, was a student at Marquette University, Milwaukee, Wisconsin at the time of the study. James Bang, PhD, is Professor, St. Ambrose University, Davenport, Iowa. Olga Yakusheva, PhD, is Associate Professor, University of Michigan, Ann Arbor. Kathleen L. Bobay, PhD, RN, NEA-BC, FAAN, is Professor, Loyola University of Chicago, Illinois. Janet Krejci, PhD, RN, is Professor and Dean of College of Nursing, Marquette University, Milwaukee, Wisconsin. Linda Costa, PhD, RN, NEA-BC, is Assistant Professor, University of Maryland, Baltimore. Ronda G. Hughes, PhD, RN, FAAN, is Associate Professor, University of South Carolina, Columbia. Morris Hamilton, PhD, is Senior Analyst, Abt Associates, Durham, North Carolina. Danielle M. Siclovan, PhD, MSN, RN, is Director, Risk Management, Froedtert Hospital, Milwaukee, Wisconsin. Marianne E. Weiss, DNSc, RN, is Professor Emerita, Marquette University, Milwaukee, Wisconsin.
Nurs Res. 2020 May/Jun;69(3):186-196. doi: 10.1097/NNR.0000000000000417.
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.
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.
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.
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.
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.
在出院护理期间促进护士分配的连续性有可能提高患者出院准备情况，这与减少再入院和急诊就诊有关。少数研究急性住院期间护士连续性的研究并未关注出院或出院后结果。
本研究旨在检验患者出院前护士分配的连续性与返回医院（再入院和急诊或观察就诊）之间的关联，包括探索通过患者出院准备情况的中介途径和单位环境及单位护士特征的调节作用。
在来自 31 家磁铁医院的 18203 名成年、外科患者样本中，采用相关路径分析设计对出院后 30 天内护士连续性对再入院和急诊或观察就诊的影响进行二次分析。还评估了通过患者自我报告和护士评估衡量的出院准备情况的中介途径。通过单位环境（患者每日每小时护士配置人数）和单位护士特征（教育和经验）的四分位数，对单位环境和护理特征的调节作用进行了检验。分析调整了患者特征、单位固定效应和单位水平聚类。
在 6441 例（35.4%）出院患者中观察到住院最后 2 天连续分配护士，再入院率降低了 0.85 个百分点（7.8%相对减少）。与急诊或观察就诊无显著关联。敏感性分析显示，在 Elixhauser 合并症指数较高的患者中，效果更强。出院准备情况不是连续性对返回医院影响的中介因素。单位特征与护士连续性无关。单位环境和护士特征没有明显的调节作用。
住院最后 2 天的护士分配连续性可降低再入院率。连续性的人员配置可能使患者和医疗系统受益，对高合并症患者的益处更大。在分配急性护理护士时，应优先考虑在出院前护士连续性，以加强减少再入院的努力。
