Development and validation of an instrument to measure nursing workload in the postanaesthesia care unit

BACKGROUND There are no instruments specifically developed for the measurement of nursing workload in postanaesthesia care units (PACUs). An objective and valid instrument is essential for planning work flow and staffing in this unique hospital environment that encompasses elements of elective and acute postsurgical care. Previous studies show that increased workload is associated with increased complication rates in ICUs. Thus, workload assessment may be an important tool for improving postsurgical outcomes. OBJECTIVE The aim of this study was to develop and validate a postanaesthesia workload instrument (PAWI) for measurement of workload in PACUs for adults above 18 years of age. DESIGN Development and validation consisted of three parts: Delphi consensus to establish content validity; internal validation including feasibility, face validity and inter-rater reliability testing; and national external validation consisting of feasibility, inter-rater reliability, criterion validity, construct and face validities. SETTING PACUs in nine university and regional hospitals in Sweden. RESULTS The final instrument consisted of 11 workload domains. The response rate was 98% and overall feasibility of PAWI was 100%. Content and face validity were demonstrated by consensus after two Delphi rounds. In national external validation, good agreement between experts was demonstrated with Cohen's κ greater than 0.75 in nine domains and 0.6 to 0.74 in the remaining two domains. A significant relationship was seen between PAWI and the nine equivalents of nursing manpower use score (NEMS) ( r = 0.439, P < 0.001). There were no floor or ceiling effects. There was a significant association between PAWI points and American Society of Anesthesiologists’ (ASA) physical status grade ( P = 0.007) but not between PAWI points and age. CONCLUSION We developed and validated PAWI, an instrument for objectively measuring workload in postanaesthesia care units. PAWI demonstrated good feasibility and metric properties.