Marga Hoogendoorn

23 I NTRODUCT I ON The Intensive Care Unit in a hospital is a labour-intense service due to its highly complex patients and the consequently high amount of care they require. Therefore, nurses can care for only a limited number of patients. A high workload and a low Nurse:Patient-ratio have shown to be associated with an increased risk for nosocomial infections in Intensive Care-patients, unplanned extubations, and an increased risk of mortality 1-5 . Although there is evidently a high need for nursing capacity, there are also constraints on the healthcare budget and the availability of educated Intensive Care nurses. It is clear that resources should be used as efficiently as possible, which means avoiding understaffing as well as overstaffing. Therefore, for managerial as well as financial reasons, quantification of the Nurse:Patient-ratio is an important issue as the costs for nursing staff comprise about 40% of total Intensive Care costs 6, 7 . Application of scoring systems to measure the amount of nursing time needed per patient, mostly translated into a Nurse:Patient- ratio, could provide insight into the required nursing capacity. This is increasingly important for Intensive Care management who has to focus on both quality and cost, including the implementation of guidelines on Nurse:Patient-ratios 8, 9 . The application of a reliable nursing workload classification system might optimize both Intensive Care and hospital costs, availability of Intensive Care beds and improve patient outcome. Due to this importance, many systems have been developed for this purpose over the years. However, the validation and application of those systems in daily practice varies strongly. The objective of this study is to systematically review the literature to identify existing scoring systems used to measure the amount of nursing care needed for Intensive Care patients, evaluate the validity and reliability and evaluate which system is most useful in daily practice in terms of quantification of the required nursing capacity. METHODS Search strategy We searched the databases MEDLINE, Cinahl, and Embase for original studies with the primary aim to develop or validate a scoring system to quantify the nursing time needed for Intensive Care patients. We checked the references of the included publications for relevant publications. We searched all literature up till 01/Mar/2018. As the earliest publications on workload scoring systems, of which some are still in use, date from the early seventies we did not restrict the commencing date.