References
The Sheffield Caseload Classification Tool: testing its inter-rater reliability
Abstract
Community nursing caseloads are vast, with differing complexities. The Sheffield Caseload Classification Tool (SCCT) was co-produced with community nurses and nurse managers to help assign patients on a community caseload according to nursing need and complexity of care. The tool comprises 12 packages of care and three complexities. The present study aimed to test the inter-rater reliability of the tool. This was a table top validation exercise conducted in one city in South Yorkshire. A purposive sample of six community nurses assessed 69 case studies using the tool and assigned a package of care and complexity of need to each. These were compared with pre-determined answers. Cronbach's alpha for the care package was 0.979, indicating very good reliability, with individual nurse reliability values also being high. Fleiss's kappa coefficient for the care packages was 0.771, indicating substantial agreement among nurses; it was 0.423 for complexity ratings, indicating moderate agreement. The SCCT can reliably assign patients to the appropriate skilled nurse and care package. It helps prioritise and plan a community nursing caseload, ensuring efficient use of staff time to deliver appropriate care to patients with differing needs.
Community nurses are key to managing long-term conditions in patients by delivering care in people's own homes. They use a wide range of skills to assess, diagnose and manage a multitude of conditions, including wounds, pains and symptoms experienced at the end of life, to help maintain an individual's independence (NHS England, 2015a). Evidence from some high-profile enquiries and reviews attributes low staffing levels with adverse outcomes and poor patient experience (Francis, 2010; Keogh, 2013; Griffiths et al, 2016). Therefore, as patient and population needs change, new and innovative approaches to healthcare and support systems are needed (Department of Health and Social Care (DHSC), 2013). This care is becoming more complex, with increasing levels of acuity and dependency in patient care (McDonald et al, 2013), and a corresponding need to undertake caseload management (Reid et al, 2008). Caseload management has been defined as a management system in which care is delivered to a defined caseload according to patient need, while ensuring equity and cost-effectiveness (Pye, 2011). Bain and Baguley (2012) viewed caseload management as a way to ensure that patients' individual needs are met by an appropriately trained clinician at the right time. The focus on caseload classification within community nursing is reinforced by government policy that prioritises care closer to home (DHSC, 2012; NHS England, 2015b) and the provision of services that enable community care. However, there is also an apparent paradox between health policies that promote more care within and closer to home and the reported decline in community nursing services.
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