Nurse Continuity at Discharge and Return to Hospital.

Area of Science:

• Nursing Science
• Health Services Research
• Patient Outcomes

Background:

• Continuity of nurse assignment during discharge care may improve patient readiness for discharge, potentially reducing readmissions and emergency department visits.
• Limited research has explored nurse continuity specifically concerning discharge and post-discharge outcomes.

Purpose of the Study:

• To investigate the association between nurse continuity in the final days of hospitalization and subsequent hospital readmissions or emergency department/observation visits.
• To explore patient readiness for discharge as a potential mediator and unit environment/nurse characteristics as potential moderators in this relationship.

Main Methods:

• A correlational path analysis was conducted on data from 18,203 adult medical-surgical patients across 31 Magnet hospitals.
• Nurse continuity during the last two days of hospitalization was assessed, along with readmissions and ED/observation visits within 30 days post-discharge.
• Patient readiness for discharge, unit environment (staffing), and nurse characteristics (education, experience) were analyzed for mediating and moderating effects, with adjustments for patient and unit factors.

Main Results:

• Continuous nurse assignment for the last two hospitalization days was linked to a 0.85 percentage point reduction in readmissions (7.8% relative reduction).
• No significant association was found between nurse continuity and emergency department or observation visits.
• Patient readiness for discharge did not mediate the effect, and unit environment or nurse characteristics did not moderate the relationship. A stronger effect was observed in high-comorbidity patients.

Conclusions:

• Nurse continuity in the final days of hospitalization is an effective strategy for reducing hospital readmissions.
• Prioritizing nurse continuity during acute care discharge planning can enhance readmission reduction efforts, particularly for high-comorbidity populations.
• Healthcare systems and patients can benefit from staffing models that promote nurse continuity.