Missed continuity of nursing and therapy care at the point of intensive care unit step-down: A scoping review

OBJECTIVES: To map evidence on missed continuity of nursing and therapy care during ICU step-down, including how continuity is conceptualised, what care is lost, contributing factors, consequences, and strategies to support continuity. METHODS: We conducted a scoping review in accordance with Joanna Briggs Institute methodology and reported using PRISMA-ScR. MEDLINE, Embase, CINAHL, Scopus, Web of Science and grey literature sources were searched from 1998 to October 2025. Eligible studies reported adult ICU-to-ward transitions involving nursing and/or therapy care continuity or missed care. Two authors independently screened and charted data. Findings were analysed through descriptive mapping and thematic synthesis. RESULTS: Of 3021 records identified, 27 studies met the inclusion criteria. The evidence was mainly qualitative and nursing-focused, with limited inclusion of therapy professionals. Continuity was most often conceptualised as informational, with evidence of incomplete handover, poor documentation, and loss of clinically relevant detail. Management continuity failures included missed monitoring, delayed review, medication discontinuity, and poor follow-through of care plans. Relational continuity involved inadequate preparation of patients and families and limited interprofessional communication. Functional continuity, including rehabilitation and mobilisation, was less frequently examined but commonly disrupted. Four themes were identified: continuity breakdown between handover and ward enactment; structural mismatch between ICU and ward environments; patient safety risks linked to missed continuity; and under-recognition of relational continuity. Findings supported a continuity cascade model in which breakdown begins before transfer and progresses across interrelated domains. CONCLUSIONS: Missed continuity of nursing and therapy care at ICU step-down is a multifaceted and under-conceptualised problem extending beyond handover. The proposed continuity cascade model suggests that breakdown occurs across anticipatory, informational, interprofessional, management, and functional/relational domains. IMPLICATIONS FOR CLINICAL PRACTICE: Interventions should address care enactment, interprofessional coordination, rehabilitation continuity, and patient and family preparation. ICU step-down should be recognised as a high-risk transition requiring structured, multidisciplinary continuity systems.