The relationship between different missed care activities and patient outcomes: A systematic review

Missed care is a key indicator of nursing quality and has been linked to negative patient outcomes. However, the rates of missed care vary across different nursing activities. Treating missed care as a composite indicator may lack specificity in relation to patient outcomes.

This review aims to explore the relationship between different missed care activities and patient outcomes.

We systematically searched PubMed, Scopus, Web of Science, and CINAHL databases for relevant studies published up to November 2024. Studies examining the relationship between missed care activities and patient outcomes were included. The risk of bias was evaluated using the NICE public health review guidelines, and the PRISMA guidelines were followed in reporting this review. The review protocol was registered on PROSPERO (CRD42024618442).

After screening, 17 articles were included. Most studies were cross-sectional, relying on nurse or patient self-reporting to assess missed care. This review found that different types of missed care activities were related to various patient outcomes. The main findings were as follows: 1) missed clinical care activities were closely linked to patient safety outcomes. Specifically, omissions in patient monitoring, basic care, treatment and symptom management were significantly associated with adverse events such as falls, readmissions, mortality, urinary tract infections, and bloodstream infections; 2) missed communication and basic care were strongly associated with reduced patient satisfaction; 3) additionally, specific patient outcomes, such as time to achieve full oral feeding and length of hospital stay, were also associated with missed clinical care activities.

Although high-quality evidence remains limited, it is clear that different missed care activities are linked to varying patient outcomes, suggesting that their effects on the patient outcomes differ across activities. Future research should focus on developing targeted intervention strategies to reduce missed care activities that are closely linked to patient outcomes.