PICOT Statement and Research References

PICOT Statement and Research References
Does Continuity of care (I) influence Length of Stay (O) in Diabetes patients who have been hospitalized in a med-surgical unit (P) during inpatient stay (T)?
Population: Hospitalized/ In-patient Medical Surgical Patients
Intervention: The nursing staff role regarding staffing assignments and concept of continuity of care
Comparison: The nursing staff role as a non-consistent or no continuity staffing assignment (staffing varies day to day)
Outcome: When the nurse staffing is maintained at continuous members per patient when available, there will be decreased readmission rates for same diagnosis over a 6-month period of time and an overall decreased need for lengthened inpatient time.
Time: Length of stay, including the 6 months post discharge.
PICOT Question:
Does the inpatient length of stay decrease for those who have access to better continuity of care in staffing assignments versus when the nurse assignment is non-continuous and varied?
Does continuity of care effect the overall readmission rate for same diagnosis readmits within a 6 month time frame?

Batch, M., Barnard, A., & Windsor, C. (2009). Who’s talking? communication and the casual/part-time nurse: A literature review. Contemporary Nurse : A Journal for the Australian Nursing Profession, 33(1), 20-9. Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/203168670?accountid=7374
The rapidly evolving nursing working environment has seen the increased use of flexible non standard employment, including part-time, casual and itinerate workers. Evidence suggests that the nursing workforce has been at the forefront of the flexibility push which has seen the appearance of a dual workforce and marginalization of part-time and casual workers by their full-time peers and managers. The resulting fragmentation has meant that effective communication management has become difficult. Additionally, it is likely that poor organizational communication exacerbated by the increased use of non-standard staff, is a factor underlying current discontent in the nursing industry, and may impact on both recruitment and retention problems as well as patient outcomes. This literature review explores the relationship between the increasing casualisation of the nursing workforce and, among other things, the communication practices of nurses within healthcare organizations.
Fletcher, K. E., Wiest, F. C., Halasyamani, L., Lin, J., Nelson, V., Kaufman, S. R., . . . Schapira, M. (2008). How do hospitalized patients feel about resident work hours, fatigue, and discontinuity of care? Journal of General Internal Medicine, 23(5), 623-8. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1007/s11606-007-0384-0

Patient-centered care requires that physicians understand patients’ perspectives. Since the resident work hour rules were instituted, little information is available about how patients perceive these issues. Our objectives were to explore patients’ knowledge, concerns, and attitudes about resident work hours, fatigue, and continuityof inpatient care and to evaluate the association between patients’ trust and satisfaction with these concerns and attitudes.
We conducted a cross-sectional survey of 134 internal medicine inpatients at 3 institutions including a tertiary care academic health center, a Veterans Affairs medical center, and a private community teaching hospital.
Mean age was 59 (range, 24-90), with 60% men and 70% white. Most patients agreed (50%) or felt neutral (38%) toward resident work hours being limited. Patients estimated that residents worked 60 h per week but thought that they should work no more than 51 h per week (p<.01 for the difference). Twenty-seven percent ofpatients had some concern about fatigue in the residents, and 28% reported concern about how often hand-offs of care occurred. Factor analysis yielded 3 factors: "worried about discontinuity/fatigue," "attitude toward resident/nurse work hours," and "perceived resident/nurse fatigue." In multivariable analyses, the "worried about fatigue/discontinuity" factor significantly predicted trust and satisfaction, and the "perceived resident/nurse fatigue" factor also predicted satisfaction. Some inpatients are concerned about both fatigue in resident physicians and discontinuity of care. This may play a role in trust and satisfaction for patients. Taking steps to design systems to minimize fatigue and discontinuity would be ideal. van Walraven, C., Taljaard, M., Bell, C. M., Etchells, E., Stiell, I. G., Zarnke, K., & Forster, A. J. (2010). A prospective cohort study found that provider and information continuity was low after patient discharge from hospital. Journal of Clinical Epidemiology, 63(9), 1000-10. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1016/j.jclinepi.2010.01.023 Continuityofcare is composed of provider and information continuity and can change value over time. Most studies that have quantitatively associated continuityofcare and outcomes have ignored these characteristics. This study is a detailed examination ofcontinuityofcare in patients discharged from hospital that simultaneously measured separate components ofcontinuity over time or determined the factors with which they are associated. Multicenter, prospective cohort study of patients discharged to the community after elective or emergent hospitalization. For all physician visits during 6 months after discharge, we identified the physician and the availability ofparticular information (including hospital discharge summary and any information from previous physician visits). Four physician continuity scores (preadmission; hospital admitting; hospital consultant; and postdischarge) and two information continuity scores (discharge summary and postdischarge visit information) were calculated for all patients (range: 0-1, where 0 is perfect discontinuity and 1 is perfect continuity). Four thousand five hundred fifty-three people were followed for a median of 175 days. Both provider (range of median values: 0-0.410) and information (range: 0.220-0.427) continuity scores were low and varied extensively over time. With a few exceptions, continuity measures were independent of each other. The influence of patient factors on continuity varied extensively between the continuity measures with the most influential factors being admission urgency, admitting service, and the number of physicians who regularly treated the patient. Both provider and information continuity was low in patients discharged from hospital. Continuity measures can change extensively over time, which are usually independent of each other, and are associated with patient and admission characteristics. PICOT Statement and Research References. Future studies should measure multiple components of provider and information continuity over time to completely capture continuity of care.

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