Continuity of Care: Designing an Innovative Nursing Care Delivery Model

Purpose for the program: To improve the continuity of care for NICU patients and families by the development and implementation of a nursing care delivery model that addresses the complex NICU environment. Our aim was to demonstrate a 25% improvement in the Continuity of Care Index (CCI) by the end of the summer 2012 pilot. The CCI is defined as the total number of nurses caring for an individual patient divided by length of stay days times 2 shifts per day. A decrease in CCI translates to improved consistency in nurse caregivers.

Proposed change: The Safety Attitudes Questionnaire (SAQ) was used to assess nursing and medical staff attitudes towards interdisciplinary communication.  Using data from the SAQ survey, our Continuity of Care Taskforce developed a nursing model (team nursing) based on geographic pod microsystems so that a team of nurses would be responsible for staffing one pod.  The staffing model was implemented in the summer of 2012 in one patient area (pod).  The nursing team model emphasizes: consistency in patient assignments for nurses, nursing team huddles to enhance communication and a daily goal sheet to enhance nurse participation in interdisciplinary team rounds. 

Implementation, outcomes and evaluation: First, we collected baseline data , including CCI and the pre-pilot nursing safety survey.  Then relevant literature was reviewed and analyzed and findings were shared with staff, physicians and leadership team.  A volunteer team of nurses was recruited for the pilot.  For our model, nursing staff was assigned as a team to one NICU pod.  After a 6 month pilot period, post-pilot CCI and safety survey results were collected.  Results included a 30% increase in staff perception of communication and teamwork, a 13% decrease in the total number of RN's per infant per hospital stay, a 28% decrease in CCI in the pilot pod and a 9% decrease in CCI in the non-pilot NICU pods.

Implications for nursing practice: This project combines a validated culture survey to help us transform our culture and develop a patient-centric microsystem approach to care delivery.  By creating a model of care that improves caregiver and family relationships and maximizes team collaboration, we expect that our care model would result in improved parent satisfaction and ultimately patient outcomes.  In the future, we plan to measure those outcomes.

Keywords:  NICU, continuity of care, team nursing, nursing care delivery model, microsystem