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Connor JA, LaGrasta C, Cerrato B, Porter C, Gauvreau K, Morrill D, Fortkiewicz J, Mechler M, Donnellan A, Kaduc A, Whalen R, Shields A, Bruno M, Jarden A, Dey A, Hickey PA. Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III. Am J Crit Care 2022; 31:119-126. [PMID: 35229150 DOI: 10.4037/ajcc2022907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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.
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Affiliation(s)
- Jean Anne Connor
- 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
| | - Christine LaGrasta
- Christine LaGrasta is a nurse practitioner III, Inpatient Cardiology, Boston Children’s Hospital
| | - Benjamin Cerrato
- Benjamin Cerrato is a project coordinator II, Cardiovascular, Critical Care and Peri-operative, Patient Care Operations, Boston Children’s Hospital
| | - Courtney Porter
- Courtney Porter is a program manager, Center for Healthy Adolescent Transition (CHAT), Clinical Services Education and Research, Children’s Hospital Los Angeles, California
| | - Kimberly Gauvreau
- 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
| | - Diana Morrill
- Diana Morrill is a project coordinator II, Cardiovascular, Critical Care and Peri-operative, Patient Care Operations, Boston Children’s Hospital
| | - Justine Fortkiewicz
- Justine Fortkiewicz is a professional practice specialist, Cardiac Intensive Care Unit (CICU), Children’s National Hospital, Washington, District of Columbia
| | - Mallory Mechler
- Mallory Mechler is the CICU clinical leader, Children’s Hospital New Orleans, Louisiana
| | - Amy Donnellan
- Amy Donnellan is a CICU nurse practitioner, Cincinnati Children’s Hospital, Ohio
| | - Alexandra Kaduc
- Alexandra Kaduc is a nurse educator, Pediatric Cardiac Care Center, Golisano Children’s Hospital, Rochester, New York
| | - Ruby Whalen
- Ruby Whalen is a clinical specialist, Cardiac ICU, Nicklaus Children’s Hospital, Miami, Florida
| | - Ashlee Shields
- Ashlee Shields is a programmatic specialist, UPMC Children’s Hospital of Pittsburgh, and an assistant professor of nursing, Robert Morris University, Pittsburgh, Pennsylvania
| | - Michelle Bruno
- Michelle Bruno is a nurse manager, Pediatric Catheterization Laboratory, Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Angela Jarden
- Angela Jarden is the RN program coordinator for the M43 and M53 Pediatric Intensive Care Units, Cleveland Clinic Children’s Hospital
| | - Anne Dey
- Anne Dey is the director of critical care, Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Patricia A. Hickey
- 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
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Ibrahim M, Szeto WY, Gutsche J, Weiss S, Bavaria J, Ottemiller S, Williams M, Gallagher JF, Fishman N, Cunningham R, Brady L, Brennan PJ, Acker M. Transparency, Public Reporting and a Culture of Change to Quality and Safety in Cardiac Surgery. Ann Thorac Surg 2021; 114:626-635. [PMID: 34843698 DOI: 10.1016/j.athoracsur.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Academic medical centers have a duty to serve as hospitals of last resort for advanced cardiac surgical care and therefore manage patients at elevated risk of post-operative morbidity and mortality. They must also meet state and professional quality targets devised to protect the public. The tension between these imperatives can be managed by a multi-dimensional quality improvement program which aims to manage risk, optimize outcomes and exclude futile operations. We here share our approach to this process, its impact on our institution and discuss pertinent issues relevant to institutions in a similar situation.
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Affiliation(s)
- Michael Ibrahim
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Gutsche
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve Weiss
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Ottemiller
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Williams
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jo Fante Gallagher
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil Fishman
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Regina Cunningham
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luann Brady
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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