Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III

Author:

Connor Jean Anne1,LaGrasta Christine2,Cerrato Benjamin3,Porter Courtney4,Gauvreau Kimberly5,Morrill Diana6,Fortkiewicz Justine7,Mechler Mallory8,Donnellan Amy9,Kaduc Alexandra10,Whalen Ruby11,Shields Ashlee12,Bruno Michelle13,Jarden Angela14,Dey Anne15,Hickey Patricia A.16

Affiliation:

1. Jean Anne Connor is the director of nursing research, Cardiovascular, Critical Care and Peri-operative, Patient Care Operations, Boston Children’s Hospital, Boston, Massachusetts, and an assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts.

2. Christine LaGrasta is a nurse practitioner III, Inpatient Cardiology, Boston Children’s Hospital.

3. Benjamin Cerrato is a project coordinator II, Cardiovascular, Critical Care and Peri-operative, Patient Care Operations, Boston Children’s Hospital.

4. Courtney Porter is a program manager, Center for Healthy Adolescent Transition (CHAT), Clinical Services Education and Research, Children’s Hospital Los Angeles, California.

5. Kimberly Gauvreau is a senior biostatistician, Department of Cardiology, Boston Children’s Hospital; an associate professor of pediatrics, Harvard Medical School; and an associate professor of biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

6. Diana Morrill is a project coordinator II, Cardiovascular, Critical Care and Peri-operative, Patient Care Operations, Boston Children’s Hospital.

7. Justine Fortkiewicz is a professional practice specialist, Cardiac Intensive Care Unit (CICU), Children’s National Hospital, Washington, District of Columbia.

8. Mallory Mechler is the CICU clinical leader, Children’s Hospital New Orleans, Louisiana.

9. Amy Donnellan is a CICU nurse practitioner, Cincinnati Children’s Hospital, Ohio.

10. Alexandra Kaduc is a nurse educator, Pediatric Cardiac Care Center, Golisano Children’s Hospital, Rochester, New York.

11. Ruby Whalen is a clinical specialist, Cardiac ICU, Nicklaus Children’s Hospital, Miami, Florida.

12. Ashlee Shields is a programmatic specialist, UPMC Children’s Hospital of Pittsburgh, and an assistant professor of nursing, Robert Morris University, Pittsburgh, Pennsylvania.

13. Michelle Bruno is a nurse manager, Pediatric Catheterization Laboratory, Cleveland Clinic Children’s Hospital, Cleveland, Ohio.

14. Angela Jarden is the RN program coordinator for the M43 and M53 Pediatric Intensive Care Units, Cleveland Clinic Children’s Hospital.

15. Anne Dey is the director of critical care, Children’s Hospital and Medical Center, Omaha, Nebraska.

16. Patricia A. Hickey is the senior vice president and associate chief nurse, Nursing and Patient Care Operations, Boston Children’s Hospital; and an assistant professor of pediatrics, Harvard Medical School.

Abstract

BackgroundThe Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload.ObjectiveTo validate the ICU CAMEO III acuity tool in US children’s hospitals.MethodsUsing a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs). Descriptive statistics were used to summarize patient, nursing, and unit characteristics. Concurrent validity was evaluated by correlating the ICU CAMEO III with the Therapeutic Intervention Scoring System-Children (TISS-C) and the Pediatric Risk of Mortality III (PRISM III).ResultsPatients (N = 840) were enrolled from 15 units (7 cardiac and 8 mixed pediatric ICUs). The mean number of ICU beds was 23 (range, 12-34). Among the patients, 512 (61%) were diagnosed with cardiac and 328 (39%) with noncardiac conditions; 463 patients (55.1%) were admitted for medical reasons, and 377 patients (44.9%) were surgical. The ICU CAMEO III median score was 99 (range, 59-163). The ICU CAMEO complexity classification was determined for all 840 patients: 60 (7.1%) with level I complexity; 183 (21.8%) with level II; 201 (23.9%), level III; 267 (31.8%), level IV; and 129 (15.4%), level V. Strong correlation was found between ICU CAMEO III and both TISS-C (ρ = .822, P < .001) and PRISM III (ρ = .607, P < .001) scores, and between the CAMEO complexity classifications and the PRISM III categories (ρ = .575, P = .001).ConclusionThe ICU CAMEO III acuity tool and CAMEO complexity classifications are valid measures of patient acuity and nursing cognitive workload compared with PRISM III and TISS-C in academic children’s hospitals.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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