Intensive care units, Nursing cognitive workload complexity, Patient acuity, Workload



  1. Connor, Jean A. PhD, RN, CPNP, FAAN
  2. LaGrasta, Christine DNP, RN, CPNP-PC/AC
  3. Gauvreau, Kimberlee ScD
  4. Porter, Courtney MPH, CPHQ
  5. O'Brien, Kendra BA
  6. Hickey, Patricia A. PhD, MBA, RN, NEA-BC, FAAN


Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity. An expert panel including representatives from 4 intensive care units (ICUs) convened to scale and implement the CAMEO II across the ICUs in a large, freestanding children's hospital in the United States.


Objectives: The aims of this study were to scale and implement a standardized acuity measure of pediatric critical care nursing.


Method: This study used a modified Delphi technique.


Results: Through a series of 3 Delphi rounds, the expert panel identified care items not characterized in the original CAMEO and assigned each of these items a cognitive workload scale of 1 to 5. The expert panel identified 4 additional Domains of Care while confirming the original 14 Domains of Care in the first CAMEO version. The panel agreed that a number of care items could be classified as "Standard of Care," reducing items in the CAMEO and generating a baseline score. The panel, serving as ambassadors and unit-based experts, then implemented the refined CAMEO II in each of the 4 ICUs.


Discussion: Utilization of the CAMEO II across ICUs provides a standardized measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure informs projection of staffing models and benchmarking across pediatric ICUs. Further research is needed to validate the CAMEO II for multisite use.