Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set.
BACKGROUND
Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes.


OBJECTIVE
The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU).


METHODS
A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care data set containing 42,403 episodes documented by 787 nurses, on nine units, in four hospitals and includes nurse staffing and patient characteristics. The HANDS data set resides in a "big data" relational database consisting of 89 tables and 747 columns of data. Via data mining, we created an analytic data set of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the association of nurse continuity and additional nurse-staffing variables on HAPU occurrence.


RESULTS
Poor nurse continuity (unit mean continuity index = .21-.42 [1.0 = optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission, as well as patient age, were associated with HAPUs (p < .001). Controlling for patient characteristics, nurse continuity, and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development.


CONCLUSIONS
Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. We demonstrated a high level of variation in the degree of continuity between patient episodes in the HANDS data, showing that it offers rich potential for future study of nurse continuity and its effect on patient outcomes.
Janet Stifter, PhD, RN, is Postdoctoral Scholar, College of Nursing, University of Illinois at Chicago. Yingwei Yao, PhD, is Research Associate Professor, College of Nursing, University of Illinois at Chicago, and College of Nursing, University of Florida, Gainesville. Muhammad Kamran Lodhi, BS, is PhD Candidate, University of Illinois at Chicago Electrical and Computer Engineering. Karen Dunn Lopez, PhD, MPH, RN, is Assistant Professor, College of Nursing, University of Illinois at Chicago. Ashfaq Khokhar, PhD, is Professor, Illinois Institute of Technology, Chicago. Diana J. Wilkie, PhD, RN, FAAN, is Earl and Margo Powers Endowed Professor, College of Nursing, University of Florida at Gainesville, and was the Harriet J. Werley Endowed Chair for Nursing Research, College of Nursing, University of Illinois at Chicago. Gail M. Keenan, PhD, RN, FAAN, is Professor and Annabel Jenks Davis Endowed Chair, College of Nursing, University of Florida at Gainesville, and was a Professor, College of Nursing, University of Illinois at Chicago.
Janet
J
Stifter
Yingwei
Y
Yao
Muhammad Kamran
MK
Lodhi
Karen Dunn
KD
Lopez
Ashfaq
A
Khokhar
Diana J
DJ
Wilkie
Gail M
GM
Keenan
D000367:Age Factors; D000368:Aged; D001775:Blood Circulation; D016022:Case-Control Studies; D057225:Data Mining; D016208:Databases, Factual; D006801:Humans; D016015:Logistic Models; D051346:Mobility Limitation; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D009752:Nutritional Status; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control; D011787:Quality of Health Care; D012307:Risk Factors; D014481:United States / Q000453:epidemiology