Association between Nurse Continuity and Mortality in the Intensive Care Unit

Area of Science:

• Critical Care Medicine
• Nursing Science
• Health Services Research

Background:

• Continuity of nursing care is a valued aspect of intensive care unit (ICU) practice.
• However, the direct impact of nurse continuity on patient outcomes, specifically mortality, remains incompletely understood.

Purpose of the Study:

• To examine the association between nurse continuity and in-hospital mortality for patients admitted to the intensive care unit.
• To investigate if higher nurse continuity correlates with improved or worsened patient survival.

Main Methods:

• A retrospective cohort study utilized electronic health records from 38 ICUs across 18 hospitals (2018-2020).
• Cumulative nurse continuity was measured as the proportion of shifts a patient received care from a returning nurse.
• Logistic regression and proportional hazards regression were employed to analyze the relationship with in-hospital mortality, adjusting for confounders.

Main Results:

• The study analyzed 47,564 ICU patients with an in-hospital mortality rate of 10.4%.
• Cumulative nurse continuity increased over time, but higher continuity showed a modest, statistically significant association with increased mortality in certain shifts.
• These findings were consistent across various sensitivity analyses, including subgroup analyses and different statistical modeling approaches.

Conclusions:

• Nurse continuity in the ICU was not found to be associated with reduced patient mortality.
• Evidence suggests that nurse continuity might be linked to increased mortality in specific intensive care settings.
• Further investigation is required to elucidate the underlying mechanisms driving the observed association between nurse continuity and ICU patient outcomes.