Continuity of patient care is frequently linked to quality care outcomes. The purpose of this paper is to examine the clinical trial literature in order to determine the extent to which informational, management, and relational continuity of care are associated with quality care indicators. A MEDLINE search of the literature via PubMed was conducted for clinical trials that were carried out from 1 January 1996-1 June 2005. Analyses of 32 unduplicated citations revealed a focus on one or more aspects of continuity and its association with quality care outcomes. Management continuity interventions were identified most often, followed by informational and relational continuity interventions. The outcomes were primarily patient-focused with a wide range of functional status, quality of life, and patient satisfaction indicators. This analysis provides implications for research that could contribute to an understanding of the types of continuity of patient care and their relationships to quality care.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify operational failures; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with operational failures in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of operational failures detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about operational failures encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 operational failures over 4,497 shifts, a rate of 6.07 operational failures per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/ Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that operational failures are frequent and varied across system processes, and that organizations may readily obtain crucial information about operational failures from frontline nurses. Nurses' detection of operational failures could provide organizations with rich, real-time information about system operations to improve organizational reliability.

Continuity of care in home health is valued but poorly understood. This article is about the delivery of nursing care to elderly home health patients and to determine if visits provided by the same RN improve selected “Outcome and Assessment Information Set” outcomes. Functional status, psychological status, and use of emergent care were examined. Cases selected represented individuals aged 65 years and older, with at least one chronic illness and a good prognosis. Patients received four or more visits from the same RN.The clinical and administrative billing records from an initial 60-day period yielded a convenience sample of 887 discharged cases from a suburban, U.S. hospital-based home health agency. Higher levels of RN continuity were associated with a decreased likelihood of neuro/emotional/behavioral issues for patients at discharge. The findings showed no relationship of RN continuity of care to functional status and use of emergent care for the period examined.

Nurses can play a meaningful role in collaborating with community lay leaders to develop and implement effective health promotion interventions for African Americans.