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An Updated Therapeutic Intervention Scoring System for Critically Ill Children Enables Nursing Workload Assessment
Randi Trope1, Sandra Vaz2, Marcia Zinger2
1Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of NY, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA rtrope@nshs.edu.
Insights
An updated Therapeutic Intervention Scoring System for critical care in children (TISS-C) was developed to assess patient acuity and nursing workload (NW). Higher TISS-C scores correlated with increased adverse events in critically ill pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Nursing Workload Assessment
- Patient Safety
Background:
- The original Therapeutic Intervention Scoring System (TISS) required an update for pediatric critical care.
- The revised TISS-C was developed to assess patient acuity and nursing workload (NW) in critically ill children.
- The study aimed to link TISS-C scores to the incidence of adverse events.
Purpose of the Study:
- To introduce an updated Therapeutic Intervention Scoring System for pediatric critical care (TISS-C).
- To assess patient acuity and nursing workload (NW) using TISS-C.
- To determine the relationship between TISS-C-derived NW and adverse events in critically ill children.
Main Methods:
- An updated TISS-C was developed by modifying the original TISS, removing inapplicable items, and adding current critical care items.
- TISS-C scores were calculated for 125 random pediatric intensive care unit (PICU) patients.
- Nursing workload (NW) was calculated as the product of TISS-C score and patient-nurse ratio (PNR).
Main Results:
- The mean TISS-C score for 125 random patients was 14.6 ± 11.8.
- Patients experiencing adverse events had a significantly higher mean TISS-C score (19.9 ± 11.6, P < .05).
- The calculated nursing workload (NW) for patients with more severe events was 33.6 ± 15.9, using a mean PICU PNR of 1.4.
Conclusions:
- Critically ill pediatric patients with higher derived nursing workload (NW) values are more susceptible to adverse events.
- A critical nursing workload threshold is postulated, beyond which the likelihood of adverse events increases.
- The TISS-C provides a valuable tool for assessing NW and potentially mitigating adverse events in pediatric critical care.
Background:
To introduce an updated version of the original Therapeutic Intervention Scoring System (TISS) applicable to critically ill children (TISS-C). This version was designed to assess patient acuity and nursing workload (NW) and to determine a relationship between such assessment and the incidence of adverse events.
Methods:
Reviewing previous versions of TISS, an updated TISS-C was developed. Items inapplicable to pediatric critical care were eliminated; items current to critical care were added; and items still valid were edited. The point system accounts for the wide range of care provided. Random patients from a predetermined period had TISS-C scores calculated. The TISS-C scores were also calculated on patients with documented adverse events. Baseline scores were compared with scores of patients in whom adverse events had occurred. We determined the pediatric intensive care unit (PICU) NW to be the product of the TISS-C score and the patient-nurse ratio (PNR).
Results:
One hundred twenty-five random patients had a mean TISS-C of 14.6 ± 11.8. Patients with any adverse event (98) had a TISS-C of 19.9 ± 11.6 (P < .05). Using our PICU mean PNR of 1.4 (20 patients/14 nurses), the NW for patients with more severe events was 33.6 ± 15.9.
Conclusions:
Critically ill pediatric patients are more vulnerable to experience adverse events when their derived NW values are high. It is postulated that a critical NW exists, where adverse events are more likely to occur.
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