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Kris-Ann Shanique Robertson, Aldo Espinoza, Kwon Ohwook, David Skale, Joseph Fan; Lack of Continuity in Nursing and Physician Care as a Potential Risk Factor for Developing Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):970.
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Retinopathy of prematurity (ROP) is a preventable cause of blindness with known modifiable risk factors. This study tested the impact of continuity in nursing and physician care as an independent and potentially modifiable risk factor for developing ROP. Continuity of care is defined as fewer nurses or physicians caring for a patient. Our hypothesis is that more continuity of care is associated with decreased prevalence and severity of ROP.
Data was collected from the Neonatal Intensive Care Units (NICU) found at two hospitals in Southern California. Based on standard inclusion criteria, babies with a birth weight of ≤1500 g or gestational age of 30 weeks or less and selected infants with an unstable clinical course were studied. For physicians, a Continuity of Care Index (COI) was recorded as a ratio of the total number of NICU physicians caring for the patient over the total number of hospital days. For nurses, the COI was calculated by dividing the number of different nurses caring for the patient by the number of nursing shifts. A higher COI is associated with less continuity of care. Multi-variate analysis of well known risk factors were also included in the analysis. ANOVA and χ2 tests were used for statistical analysis.
The mean COI for physicians was 0.14 and was not associated with the development of ROP (p< 0.05, SEM=0.003). Those who developed ROP had a mean COI of 0.12 (p< 0.05, SEM=0.004). The mean COI for nurses was 0.39 and was not associated with the development of ROP (p< 0.05, SEM=0.007). Those who developed ROP had a mean COI of 0.33 (p< 0.05, SEM=0.011). Post Hoc test for both physicians and nurses showed COI for ROP and severe ROP were not significantly different from each other (p>0.05).
Higher continuity of care is associated with increased incidence of ROP, which was opposite of the study hypothesis. Our results indicate that the relationship between ROP and continuity in physician and nursing care is complex. Patients with ROP tend to be sicker and these results may reflect proper delegation of staff to sicker patients in order to improve continuity. We were unable to compare the severity of ROP given our limitations in sample size. Continuity may play a role in patients who develop ROP and further research is warranted comparing these groups.
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