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Simplified Therapeutic Intervention Scoring System: the TISS-28 items--results from a multicenter study
D R Miranda1, A de Rijk, W Schaufeli
1Department of Surgery, University Hospital of Groningen, The Netherlands.
Critical Care Medicine
|January 1, 1996
Summary
The simplified Therapeutic Intervention Scoring System (TISS-28) accurately reflects the original TISS-76, explaining 86% of its variation. This validated tool can replace TISS-76 in intensive care units (ICUs) for efficient nursing activity assessment.
Area of Science:
- Critical Care Medicine
- Nursing Administration
- Health Services Research
Background:
- The Therapeutic Intervention Scoring System (TISS-76) is a comprehensive tool for measuring nursing workload in intensive care units (ICUs).
- A simplified version, TISS-28, was developed to streamline the assessment process.
- Validation of TISS-28 against TISS-76 and its correlation with actual nursing time are crucial for clinical adoption.
Purpose of the Study:
- To validate the simplified Therapeutic Intervention Scoring System (TISS-28) against the original TISS-76.
- To assess the association between TISS-28 scores and the time nurses spend on various scored and non-scored activities in the ICU.
- To determine the clinical utility of TISS-28 for workload measurement in intensive care settings.
Main Methods:
- A prospective, multicenter study involving 22 Dutch ICUs and 903 patients.
- TISS-28 was derived from TISS-76 data using multivariable regression analysis and cross-validated.
- Nursing activities were inventoried and categorized, with time allocation assessed using work sampling over a 1-week period.
Main Results:
- TISS-28 explained 86% of the variation in TISS-76 scores (r = .93, r² = .86), demonstrating strong correlation.
- Analysis of work sampling data showed a significant increase in time spent on TISS-28 scored activities as scores increased.
- A typical nurse was found to deliver nursing activities equivalent to 46.35 TISS-28 points per shift, with time allocation varying by shift and patient acuity.
Conclusions:
- The TISS-28 is a valid and reliable simplified version of the TISS-76, suitable for replacing the original system in clinical practice.
- TISS-28 effectively correlates with nursing workload and time spent on patient care activities in the ICU.
- The findings support the use of TISS-28 for objective workload assessment and resource management in intensive care units.