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The Effect of Continuity in Nursing Care on Patient Outcomes in the Pediatric Intensive Care Unit

Siow, Elaine PhD, RN; Wypij, David PhD; Berry, Patricia RN; Hickey, Patricia PhD, MBA, RN, FAAN; Curley, Martha A. Q. PhD, RN, FAAN

doi: 10.1097/NNA.0b013e31829d61e5

BACKGROUND: Previous studies have examined the links between continuity of care and patient outcomes, but little is known about this relationship in acute care pediatric settings.

OBJECTIVE: The aim of this study was to examine the associations between continuity in nursing care (CINC), defined as fewer nurses caring for a patient, and patient outcomes in a pediatric intensive care unit (ICU).

METHODS: A secondary analysis of prospectively collected data was carried out.

RESULTS: A total of 332 patients admitted to the medical/surgical ICU at Children’s Hospital Boston from March 2004 to December 2012 were included in the study. The mean (SD) Continuity of Care Index score was 0.4 (0.1). Multivariable analyses demonstrated that CINC was associated with a longer ICU stay (P < .001) and longer ventilator days (P = .01) but was not associated with the occurrence of adverse events and ICU-acquired infections. When a match between nurse expertise and mortality risk was included as interaction term, CINC was significantly associated with fewer nurse-sensitive adverse events (P = .05).

Conclusions: In this study, sicker patients were more likely to receive more CINC. Continuity in providers may have the potential to affect patient outcomes. More studies are needed to explore this relationship.

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Author Affiliations: Assistant Professor (Dr Siow), Academic Programs Division, Singapore Institute of Technology, Singapore; Senior Biostatistician, Department of Cardiology (Dr Wypij); Nurse Coordinator, Virtual PICU, Medical/Surgical Intensive Care Unit (Ms Berry); Vice President, Cardiovascular and Critical Care Services (Dr Hickey), Boston Children’s Hospital, Massachusetts; AssistantProfessor of Pediatrics (Dr Hickey), Harvard Medical School, Boston, Massachusetts; Ellen and Robert Kapito Professor in Nursing Science (Dr Curley), School of Nursing, Anesthesia and Critical Care Medicine, University of Pennsylvania, Philadelphia.

The authors declare no conflicts of interest.

Correspondence: Dr Siow, Singapore Institute of Technology, 25 North Bridge Road, 02-00 EFG Building, Singapore 179104 (

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