A systematic review of the impact of 'missed care' in primary, community and nursing home settings

Aim To explore 'missed care' in relation to primary and community settings, including nursing homes, and to build an understanding of implications for patients, public, politicians and policymakers. Background Missed care occurs when any aspect of required patient care is omitted or delayed. Little attention has examined missed care in primary, community and nursing home settings. Methods Systematic review of the literature. Searches were conducted of PubMed, CINAHL, Google Scholar (July 2018). The quality of empirical studies was appraised using CASP and SURE tools. Results The search identified 15 metrics papers (2004-2019) and eight empirical papers (2015-2018) (five studies). Empirical studies were rated as good quality. Missed care impacts on safety in community/primary care contexts and differs from acute care. Causes of missed care include acuity, complexity of cases, volume of care and organisational factors. Metrics have been adapted to community/nursing home settings but not in a standardised way. Tools are required to evaluate missed care within a culture of personal reflection and quality improvement. Conclusion The prominence of missed acute care should not distract from its impact in primary, community and nursing home settings. Nurse leaders should consider causes for missed care, and how it is conceptualized and evaluated. Implications for Nursing Management This review offers evidence for exploring, measuring and evaluating missed care locally.