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UNLABELLED: . Systems for the assessment of patients' complexity: a narrative review of the literature.

INTRODUCTION: An effective and efficient caseload management ensures that patients receive the right care by the right person at the right time. Several systems are used in Italy to measure patients' complexity.

AIM: To describe and compare the characteristics of the systems for measuring patients' complexity, used in Italy from 1994 to 2015.

METHODS: A search was conducted on PubMed, CINAHL, Medline, Cochrane Library, and on Google, with the same key-words. Systems dedicated to paediatric and intensive care patients were not included. The variables used to define complexity were classified according to 4 dimensions of the Italian model of Complexity of Nursing care (autonomy/dependence, stability/instability; comprehension and choice; context).

RESULTS: Eight systems were identified, each using a different set and number of variables to define patients' complexity. For 5 systems the most influential dimension on the final score was the autonomy/dependence (from 74% to 34% of the final score). The Caring professional method (MAP), the Assessment on Nursing Intensity and clinical Complexity (IACC) and the Nursing Assessment of Complexity of Care (Per.V. In.Ca.) assign an higher score to the clinical stability/instability dimension. The dimension that contributes less to the final score is the Comprehension and choice (33% for one system but no more than 11-20% for all the others) and Context (from 0 to 30%).

CONCLUSIONS: The systems are evolving from an assessment of nursing activities to the assessment of patients' conditions. The informatization of these systems will offer a valuable support to the definition of the right caring mix.