Workload scoring systems in the Intensive Care and their ability to quantify the need for nursing time: a systematic literature review

ABSTRACT Introduction The Intensive Care Unit is a resource intenseservice with a high nursing workloadper patient resulting in a low ratio of patients per nurse. This review aims to identify existing scoring systems for measuring nursing workloadon the Intensive Care and assess their validity and reliability to quantify the needed nursing time. Methods We conducted a systematic review of the literature indexed before 01/Mar/2018 in the bibliographic databasesMEDLINE, Embase, and Cinahl. Full-text articles were selected and data on systems measuring nursing workloadon the Intensive Care and translation of this workloadinto the amount of nursing time needed was extracted. Results We included 71 articles identifying 34 different scoring systems of which 27 were included for further analysis as these described a translation of workloadinto nursing time needed. Almost all systems were developed with nurses. The validity of most scoring systems was evaluated by comparing them with another system (59%) or by using time measurements (26%). The most common way to translate workload-scores into nursing time needed was by categorizing the Nurse:Patient-ratios. Validation of the Nurse:Patient-ratios was mostly evaluated by comparing the results with other systems or with the actual planning and not with objective time measurements. Conclusion Despite the large attention given to nursing workloadsystems for Intensive Care, only a few systems objectively evaluated the validity and reliability of measuring nursing workloadwith moderate results. The Nursing Activity Score system performed best. Poor methodology for the translation of workloadscores into Nurse:Patient-ratio weakens the value of nursing workloadscoring systems in daily Intensive Care practice.