Development of Complexity Assessment and Monitoring to Ensure Optimal Outcomes Acuity Curves.

BACKGROUND

The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to inform nurse staffing decisions and projections. We propose a novel use of the CAMEO data, ie, CAMEO Acuity Curves, to identify high-acuity periods after congenital heart surgery.

OBJECTIVES

The aims of this study were to describe CAMEO acuity scores for selected congenital heart surgeries and examine acuity trends during the cardiac intensive care unit (CICU) admissions.

METHODS

We performed a retrospective review of 3 common congenital heart procedures between January 2017 and January 2020: stage I palliation for single ventricle (stage I), Arterial Switch Operation (ASO) for dextro transposition of great arteries with or without ventricular septal defect repair (ASO), and tetralogy of Fallot repair. Postoperative acuity was assessed using CAMEO Acuity Curves stratified by severity of residual lesions in anatomic area of repair as assessed by the Residual Lesion Score (RLS).

RESULTS

Among 205 cases (stage I, n = 45; ASO, n = 60; tetralogy of Fallot repair, n = 100), the overall mean CAMEO scores varied in acuity by procedure, with the highest acuity during cardiac intensive care unit stay noted for stage I (76%), followed by ASO (69%) and tetralogy of Fallot repair (62%). When stratified by RLS, acuity increased for each procedure, with RLS 3 having a higher acuity than RLS 1 and 2.

DISCUSSION: The CAMEO Acuity Curves enabled construction of postoperative acuity timeline in cardiac intensive care unit, allowing description and comparison of acuity across various case complexities, which may guide clinical decision-making and optimize staffing to meet patient care resource needs.