The SIPI for measuring complexity in nursing care: evaluation study

The traditional model for nursing staff management widely used in Italian hospitals assumes that diagnosis determines the amount of nursing required, but this has been widely criticized. In order to quantify and monitor the fluctuation of the complexity in nursing care, a questionnaire, called SIPI (Sistema Informativo della Performance Infermieristica), that is based on the care needs expressed by the patients, has been proposed in the Monza Hospital.

A group of trained nurses were asked to indicate their own perception of the level of nursing day-care complexity provided to each patient and then to complete the SIPI.

The Monza Hospital coordinated this multi-centre study that involved 25 Hospitals of North Italy.

Each hospital contributed with a minimum of three units, at least one for each area of intensity of clinical care, as defined by health regulators. All adult in-patients being in the units from at least 24h were included in the survey. Psychiatric wards, neonatology, intensive and semi-intensive care wards were non considered.

A group of nurses trained with the use of SIPI completed the questionnaires based on the nursing file of performed activities. Before filling the questionnaire, the nurses were asked to indicate their perception of the level of complexity of the day-care provided to each patient. In order to calculate the SIPI scores that discriminate different nurse complexity levels, a ROC analysis and the multinomial logistic regression model were used, considering the perceived complexity as the standard of reference.

The nursing day-care complexity was measured in 115 wards, for a total of 17,803 completed questionnaires. Nursing complexity was roughly the same in areas of different intensity of clinical care, both according to perception and as measured by SIPI. A cut-off of 49.2 was identified as optimal to distinguish two classes of complexity with a good performance (80% of specificity, 85% of sensitivity).

The SIPI was shown to be a simple and useful tool that may be adopted in the future for an optimal allocation of nursing resources. The results of this study confirmed that elevated intensity of care from the clinical perspective does not necessarily correspond to high nursing complexity.