Updating the institutional parameters of the Perroca Patient Classification System: an applied methodological study

Abstract

Objective: To present the update process of institutional parameters for applying the Perroca Patient Classification System. Method: Applied methodological study conducted by the working group responsible for managing the classification of hospitalized adult patients in a large university hospital located in southern Brazil. The study was carried out between June 2024 and August 2025 in six stages, including the process for revising and updating parameters; internal and external audits of inter-rater agreement; final review and institutional communication with the updated instructions and the related standard operating procedure; and incorporation of the updated parameters into the electronic health record. Results: Although the final classification/stratum agreement between evaluations was satisfactory, the areas of planning and coordination of care, investigation and monitoring, and health education presented negative outcomes. This was addressed in institutional communication to avoid subjectivity in assessment, which, according to the audit results, tends to occur at some level. Conclusion: An institutional guideline set is presented for each of the 36 instrument items used for patient classification. These guidelines do not replace the original scale but support the complexity of the studied hospital and the innovations within contemporary nursing practice.