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

Abstract

Background The 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. Objective To validate the ICU CAMEO III acuity tool in US children’s hospitals. Methods Using 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). Results Patients (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). Conclusion The 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.

Transferring With TACT

“…When comparing the characteristics derived from Kunz et al, 14 the following were added to the first draft of the TACT: length of time off positive pressure respiratory support, length of time off high or low-flow nasal cannula, and length of time since last apneic event. 14 Next, the study team added characteristics that could affect patient transfer including surgery, patient Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) scores, 17 and changes to narcotic or benzodiazepine regimens. At the end of phase 1, the first draft of the TACT included 36 characteristics for experts to consider during phase 2 of this study.…”