Methods Inf Med 2007; 46(04): 410-415
DOI: 10.1160/ME0387
 
Schattauer GmbH

Impact of Different Sampling Strategies on Score Results of the Nine Equivalents of Nursing Manpower Use Score (NEMS)

A. Junger
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
,
B. Hartmann
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
,
J. Klasen
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
,
F. Brenck
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
,
R. Röhrig
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
,
G. Hempelmann
1   Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
20 January 2018 (online)

Summary

Objective: Prospective observational study to assess the impact of two differentsampling strategies on the score results of the NEMS, used widely to estimate the amount of nursing workload in an ICU.

Methods: NEMS scores of all patients admitted to the surgical ICU over a one-year period were automatically calculated twice a day with a patient data management system for each patient day on ICU using two differentsampling strategies (NEMSindividual: 24-hour intervals starting from the time of admission; NEMS8a.m.: 24-hour intervals starting at 8 a.m.).

Results: NEMSindividual and NEMS8a.m. were collected on 3236 patient days; 687 patients were involved. Significantly lower scores were found for the NEMS8a.m. (25.0 ± 8.7) compared to the NEMSindividual (26.1 ± 8.9, p <0.01); the interclass correlation coefficient (ICC) was good but not excellent: 0.78. The inter-rater correlation between the two NEMS scores was high or very high (κ = 0.6-1.0) for six out of nine variables of the NEMS.

Conclusions: Different sampling strategies produce different score values, especiallydueto the end of stay. This has to betaken into accountwhen using the NEMS in quality assurance projects and multi-center studies.

 
  • References

  • 1 Buist M. Intensive care unit resource utilisation. Anaesth Intensive Care 1994; 22 (01) 46-60.
  • 2 Malstam J, Lind L. Therapeutic intervention scoring system (TISS) – a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand 1992; 36 (08) 758-63.
  • 3 Metnitz PG, Valentin A, Vesely H, Alberti C, Lang T, Lenz K. et al. Prognostic performance and customization of the SAPS II: results of amulticenter Austrian study Simplified Acute Physiology Score. Intensive Care Med 1999; 25 (02) 192-7.
  • 4 Martin J, Schleppers A, Fischer K, Junger A, Kloss T, Schwilk B. et al. Der Kerndatensatz Intensivmedizin: Mindestinhalte der Dokumentation im Bereich der Intensivmedizin. Anasthesiologie & Intensivmedizin 2004; 45 (04) 207-16.
  • 5 Miranda DR, de Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System: the TISS-28 items – results from a multicenter study. Crit Care Med 1996; 24 (01) 64-73.
  • 6 Miranda DR, Moreno R, Iapichino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 1997; 23 (07) 760-5.
  • 7 Michel A, Benson M, Junger A, Sciuk G, Hempel-mann G, Dudeck J. et al. Design principles of a clinical information system for intensive care units (ICUData). Stud Health Technol Inform 2000; 77: 921-4.
  • 8 Benson M, Junger A, Quinzio L, Fuchs C, Michel A, Sciuk G. et al. Influence of the method of data collection on the documentation of blood-pressure readings with an Anesthesia Information Management System (AIMS). Methods Inf Med 2001; 40 (03) 190-5.
  • 9 Junger A, Brenck F, Hartmann B, Klasen J, Quinzio L, Benson M. et al. Automatic calculation of the nine equivalents of nursing manpower use score (NEMS) using a patient data management system. Intensive Care Med 2004; 30 (07) 1487-90.
  • 10 Nadkarni PM, Marenco L, Chen R, Skoufos E, Shepherd G, Miller P. Organization of heterogeneous scientific data using the EAV/CR representation. J Am Med Inform Assoc 1999; 06 (06) 478-93.
  • 11 Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986.
  • 12 Schönhofer B, Lefering R, Suchi S, Köhler D. Umfrage zur Einschätzung von Score-Systemen durch Intensivmediziner. Intensivmed 2002; 39: 240-5.
  • 13 Goldhill DR, Withington PS. Mortality predicted by APACHE II. The effect of changes in physiological values and post-ICU hospital mortality. Anaesthesia 1996; 51 (08) 719-23.
  • 14 Clermont G, Angus DC, Linde-Zwirble WT, Lave JR, Pinsky MR. Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data. Chest 1998; 113 (02) 434-42.
  • 15 Junger A, Bottger S, Engel J, Benson M, Michel A, Rohrig R. et al. Automatic calculation of a modified APACHE II score using a patient data management system (PDMS). Int J Med Inform 2002; 65 (02) 145-57.
  • 16 Junger A, Engel J, Benson M, Bottger S, Grabow C, Hartmann B. et al. Discriminative power on mortality of a modified Sequential Organ Failure Assessment score for complete automatic computation in an operative intensive care unit. Crit Care Med 2002; 30 (02) 338-42.
  • 17 Shabot MM, Leyerle BJ, LoBue M. Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet. Am J Surg 1987; 154 (01) 72-8.
  • 18 Liaskos J, Mantas J. Measuring the user acceptance of a Web-based nursing documentation system. Methods Inf Med 2006; 45 (01) 116-20.
  • 19 Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974; 02 (02) 57-60.
  • 20 Bundesministerium für soziale Sicherheit und Generationen. 4. LKF-Rundschreiben zum Datensatz Intensiv. Bundesministerium für soziale Sicherheit und Generationen, Wien, Österreich. 21-3-2002.2002.
  • 21 Hammond J, Johnson HM, Varas R, Ward CG. A qualitative comparison of paper flowsheets vs a computer-based clinical information system. Chest 1991; 99 (01) 155-7.
  • 22 Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: update 1983. Crit Care Med 1983; 11 (01) 1-3.
  • 23 Chen LM, Martin CM, Morrison TL, Sibbald WJ. Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med 1999; 27 (09) 1999-2004.
  • 24 Polderman KH, Jorna EM, Girbes AR. Interobserver variability in APACHE II scoring: effect of strict guidelines and training. Intensive Care Med 2001; 27 (08) 1365-9.
  • 25 Polderman KH, Christiaans HM, Wester JP, Spijkstra JJ, Girbes AR. Intra-observer variability in APACHE II scoring. Intensive Care Med 2001; 27 (09) 1550-2.