Results of an integrative review of patient classification systems.

This chapter presents the findings of an integrative review of the literature to identify current practices related to patient classification systems (PCSs). We sought to determine if there was a "gold standard" PCS that could be adopted or adapted for use by nurse leaders in practice. Sixty-three articles reporting studies related to PCS, Patient Acuity Systems or Workload Management Systems from 1983 to 2010 and applicable for inpatient medical/surgical settings were reviewed. Generally, we found that many of the criticisms of earlier PCSs are still evident: (1) difficulties with measuring workload remain an overarching theme throughout the literature; (2) definitions and descriptions of nursing work continue to be deemed inadequate; (3) there is insufficient evidence of reliability and validity testing of PCSs; and (4) there is still a need to identify nursing sensitive performance indicators and outcomes. We identified characteristics of promising PCSs, but concluded that no consensus exists about PCSs. We suggest that any approach to predicting staffing should seek to be parsimonious, minimize additional workload, be based on expert nurse judgment, be a true reflection of nursing work, and include indicators that measure patient complexity, required nursing care, available resources, and relevant organizational attributes.