Validity and reliability of medical and surgical oncology patient acuity tools.
OBJECTIVE
To develop valid and reliable medical and surgical acuity tools as part of an overall classification system for patients with cancer.


METHODS
An acute care, tertiary, research, academic oncology hospital in the southeastern United States.


METHODS
Clinical nursing experts in medical and surgical oncology; 125 patient observations for the surgical oncology acuity tool, and 75 patient observations for the medical oncology acuity tool.


METHODS
The nursing division developed a medical oncology acuity tool and a surgical oncology acuity tool using the Johns Hopkins Oncology Patient Classification System as a model. They then studied the validity of developed tools using content validity indexes (CVIs). Two independent raters studied the interrater reliability of each tool.


RESULTS
CVIs for items on the surgical tool ranged from 0.57-1.0; the overall CVI for this tool was 0.86. CVIs for items on the medical tool ranged from 0.25-1.0. The overall CVI for this tool was 0.88. Pearson correlation coefficients were r = 0.95 (p < 0.001) for the surgical oncology acuity tool and r = 0.92 (p < 0.001) for the medical tool. Interrater reliability, tested continually for four years, was greater than 95%.


CONCLUSIONS
The tools are reliable and valid.


CONCLUSIONS
Medical and surgical oncology acuity tools that are nursing diagnosis based, interface with nursing standards of care, are easy to use, and require no calculation provide reliable quantification of nursing work loads based on the care needs of patients with cancer. Supervisors use data from these tools to determine variable nursing hours per patient per day, establish productivity for units, make staffing and scheduling decisions, assign patients, work on budgets, and, ultimately, establish charges for nursing services. As the needs of medical and surgical oncology patients evolve, continued refinement of indicators and acuity levels will be needed. As other medical and surgical oncology tools are developed, further comparison will be warranted. Additional study would determine if the tools could be modified for these nursing uses in other cancer centers as well as in designated medical and surgical oncology units of other types of hospitals. Oncology acuity systems also could be established in the future as the basis for third-party reimbursement.
Ambulatory Services, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa.
R B
RB
Lovett
M B
MB
Reardon
B K
BK
Gordon
S
S
McMillan
D002173:Cancer Care Facilities; D005431:Florida; D006744:Hospital Bed Capacity, 100 to 299; D006801:Humans; D009369:Neoplasms / Q000451:nursing* / Q000601:surgery; D015588:Observer Variation; D010361:Patients / Q000145:classification*; D015203:Reproducibility of Results; D012720:Severity of Illness Index