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Complexity of care among pediatric patients in acute care settings: A systematic integrative review
Rocío García-Ruiz1, Jordi Adamuz-Tomás2, María Ruiz-Montaño3
1Ramón y Cajal University Hospital, Ctra. Colmenar Viejo Km. 9,100, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, C/Avenzoar, 6, 41009 Seville, Spain; Research Group PAIDI-CTS 1141 "Clinical Research Applied to Care and New Care Paradigms (ICCAPA)", Institute of Biomedicine of Seville (IBIS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.
Insights
This review identifies 48 factors influencing pediatric care complexity, including clinical, environmental, provider, and organizational aspects. Further research is needed to understand healthcare professionals' perceptions and impact on outcomes.
Area of Science:
- Pediatric Healthcare Research
- Nursing Science
- Health Services Research
Background:
- Complexity of care is recognized but under-researched in pediatrics, often neglecting non-medical factors.
- Existing pediatric research on care complexity primarily focuses on medical aspects.
Purpose of the Study:
- To identify evidence regarding the complexity of care in pediatric patients within acute care settings.
- To comprehensively map factors contributing to pediatric care complexity.
Main Methods:
- Integrative review following PRISMA guidelines.
- Searched PubMed, CINHAL, Scopus, and Web of Science (WOS) for articles up to July 2025.
- Independent quality and internal validity assessment by two reviewers.
Main Results:
- Analyzed 22 articles, identifying 48 complexity-related factors and 39 assessment scales.
- Key factors fall into four categories: clinical (diagnosis, stability), environmental (family involvement), care provider (nursing activities, workload), and organizational (staff experience).
Conclusions:
- Expands understanding of care complexity beyond patient pathology in pediatrics.
- Highlights the need to explore healthcare professionals' perceptions and the influence of identified factors on health outcomes.
- Suggests developing integrated assessment tools to improve pediatric care planning and resource allocation.
Background:
The concept of complexity of care is well established in scientific literature; however, in pediatric populations, research has primarily focused on medical aspects, lacking a comprehensive approach that includes additional influencing factors.
Purpose:
This study aimed to identify the evidence on complexity of care among pediatric patients attending pediatric acute care settings.
Methods:
An integrative review was conducted the PRISMA guidelines (PROSPERO registration: CRD42023469426). The search included articles published up to July 2025 in PubMed, CINHAL, Scopus, and WOS. Both the quality and internal validity of the studies included were independently assessed by two reviewers.
Results:
Twenty-two articles were analysed, identifying 48 complexity-related factors and 39 assessment scales. Findings were grouped into four thematic categories, within each of which the following key complexity factors were identified: A) Clinical aspects of pediatric patients, such as diagnosis, patient type, and clinical stability; B) Environmental factors, particularly family involvement; C) Care provider aspects, such as direct/indirect nursing activities and workload; D) Organisational elements, especially nursing staff experience.
Conclusions And Implications:
This review expands the understanding of complexity beyond patient pathology. It underscores the need for further research to explore healthcare professionals' perceptions of complexity and examine how the identified factors influence health outcomes. Developing integrated assessment tools may enhance care planning and resource allocation in pediatric settings.
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