Simplified Therapeutic Intervention Scoring System Research Articles

Mapping nursing interventions using the Therapeutic Intervention Scoring System in bloodless liver transplantations

BackgroundThe Simplified Therapeutic Intervention Scoring System adapted to liver transplantation by King's College Hospital rank 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs. ObjectivesTo evaluate nursing activities of “King’s-TISS” score grouped in organ systems and nurse patient ratio in the perioperative 48 hours of blood product free liver transplantations (LT). MethodsThe “King’s-TISS” score’s were analysed by nursing procedures and grouped, scored according to organ systems. The nursing workloads were studied during LT (T1), on arrival on the ICU (T2) and 12–24-48 hours after LT (T3-T4-T5). ResultsThe total of “King’s-TISS” score points were decreased by ≥20% daily (p = 0.001). The mean score of 104 ± 3.5 points (CI:104–105) during LT decreased to 84.7 ± 12 points (CI:83–86) in 48 hours (T5). The “metabolic” and “haemostasis” points increased (p = ).01), the “immunology” points unchanged (T2-T5) postoperatively. A slight decrease was observed in case of “basic nursing care”, “monitoring”, “neurologic support”, “renal support” and “cardiovascular support” points (T2-T5, p < .01). The “invasive intervention” and “ventilatory support” points strongly decreased (T2-T5, p < .001). One “King’s-TISS” point was found to equal 7.4 minutes with a nurse patient ratio of 2:1 intraoperatively and 1:1 postoperatively. ConclusionAbsence of blood product administration in LT decreases the total and organ specific workload, except the metabolic, haemostasis, immunology and basic support requirement. It was not within the scope of the King’s-TISS score to analyse the application of viscoelastic haemostasis test and coagulation factor concentrate administration.

Validation of a Therapeutic Intervention Scoring System (TISS-28) in critically ill children

IntroductionThere are numerous scales in intensive care units that are used to quantify the severity of patients. Most of them are very useful, although sometimes laborious to complete, thus limiting their use in usual practice. One of these scales, the Therapeutic Intervention Scoring System (TISS-76), has been validated in adult and paediatric units. Its simplified and updated version, the Simplified Therapeutic Intervention Scoring System (TISS-28), has not yet been validated in paediatric units. The aim of this study is to validate TISS-28, in order to have a simple and rapid scale. Material and methodA prospective non-interventional observational study was conducted in a Paediatric Intensive Care Unit (PICU) of a university hospital. Data were collected from 935 consecutive patients admitted to the PICU over a 3-year period. These included the values of TISS-76 and TISS-28 during the first 4 days of admission and the subsequent outcome of the patients. ResultsThe mean values of TISS-76 and TISS-28 for the first day of admission were 18.27 and 18.02, respectively. Values were higher in patients who had sequelae or died (17.58 versus 27.23 and 37.44, respectively for TISS-76 (p<.01); and 17.51 versus 23.80 and 33.44, respectively for TISS-28 (p<.01).A very good correlation was found between TISS-76 and TISS-28, with Pearson correlation and intraclass correlation coefficients >0.9 (except for the 2nd day). The correlation equation for the overall 4 days was: TISS-76=−1.74+1.05×TISS-28. TISS-28 was able to explain 82.4% of variability of TISS-76. The area under the curve with a confidence interval (CI) of 95% for the first day was 0.80 (0.73–0.87) for TISS-76, and 0.76 (0.67–0.84) for TISS-28. ConclusionsOn observing the results obtained, TISS-28 can replace TISS-76 in our PICU, without worsening the information provided. Being a reliable scale and easier to apply, its practical application could be useful.

Evaluation of the simplified therapeutic intervention scoring system: Chinese version

ObjectiveTo prepare the Simplified Therapeutic Intervention Scoring System (TISS-28) to measure nursing workload in Intensive Care Units in Guangdong Province of China. MethodsA non-experimental descriptive study was conducted in the intensive care units in the Province. TISS-28, TISS-76, Acute Physiology and Chronic Health Evaluation (APACHE II) were all measured. ResultsThere were significant positive correlations between TISS-28 and APACHE II (n=91, r=0.432, p<0.001), TISS-76 scores (n=83, r=0.764, p<0.001). A significant difference was found between the mean TISS-28 score in the first day of the intensive care stay and the last day (30.76±6.86 vs 24.67±5.48, p<0.001). A significant intra-class correlation was found between TISS-28 scores collected by the researcher and research associates (ICC=0.959, p<0.001). ConclusionThe reliability and validity of TISS-28 were shown in Chinese intensive care units. It is a practical tool for estimating the nursing workload and providing opportunities to compare the data between intensive care units in different facilities. The TISS-28 Chinese version is recommended to guide the allocation of nursing manpower in Chinese intensive care units.

Research on the nursing dynamic management according to TISS-28 in the elderly ICU

Objective To measure the daily nursing workload by simplified therapeutic intervention scoring system and provide information for reasonable dynamic management of nursing manpower and improving nursing service satisfaction of patients in elderly ICU.Methods 113 patients in elderly ICU were selected from July 2012 to June 2013.The Therapeutic Intervention Scoring System 28(TISS-28) was used to measure the nursing workload,reasonably arranged the nursing staff according to the daily total nursing workload.The average daily working time and service satisfaction were compared before and after the application of dynamic management of nursing manpower.Results After the application of dynamic management of nursing manpower,the average daily working time of nurses decreased,satisfactory degree of patients with nursing service increased,and satisfactory degree of medical workers with nursing manpower management also increased.Conclusions Measurement of nursing workload by TISS-28 can provide the basis for the dynamic management of nursing manpower in elderly ICU and improve satisfaction degree of medical workers. Key words: Intensive care unit; Simplified therapeutic intervention scoring system; Nursing manpower management; Nursing work time; Satisfaction degree

Determining delirium and risk factors of patients in cardiovascular surgery intensive care unit

Background: This study aims to determine delirium and risk factors in patients in cardiovascular surgery intensive care unit (ICU). Methods: The study included 55 patients who were hospitalized in the cardiovascular surgery ICU of a university hospital. Between March 2008 and April 2009, the study data were collected using the patient information form prepared by the researchers, confusion evaluation method in ICU, Glasgow coma scale (CKS), Richmond agitation sedation scale (RASS), acute physiology and chronic health evaluation (APACHE II) and simplified therapeutic intervention scoring system (TISS-28). Data were analyzed with chi-square, Fischer exact chi-square, t-test, and Mann-Whitney U-test. Results: Delirium occurred in 18.2% (n=10) of the patients. Eighty percent of the patients in which delirium developed had hypoactive type. The points of APACHE II, RASS, TISS-28 among ICU scores increased in the group with delirium. The mortality rate of the patients with delirium was higher compared to the patients without delirium. However, the difference was statistically significant. The length of stay in the ICU was also longer for the patients with delirium. Conclusion: Delirium is a more common pathology than estimated in cardiovascular surgery intensive care patients, particularly presenting with hypoactive type. Nurses have important roles and responsibilities in determining the signs of delirium in patients in the ICU in early stages. Therefore, educating nurses on using delirium assessment scales is essential for the safety of patients and increasing quality of care.

Validity and reliability of the simplified Therapeutic Intervention Scoring System in intensive care units of a public sector hospital in Johannesburg

Purpose. To introduce the simplified Therapeutic Intervention Scoring System (TISS-28) and to employ the original Therapeutic Intervention Scoring System (TISS-76) and Simplified Acute Physiological Score (SAPS) version II in critically ill adult patients in order to describe the validity and reliability of TISS-28 as a suitable measure of quantifying nursing workload in the adult intensive care units (ICUs) of a public sector hospital in Johannesburg. Objectives. To describe the profile of patient admissions to the ICUs, to investigate the impact of the patients’ profile on the requirements for nursing workload, and to validate the use of the TISS-28 as a measure for quantifying nursing workload in this setting. Design. A non-experimental, comparative, correlation and prospective two-staged design was utilised to meet the study objectives. Stage I involved face and content validation of TISS-28 by a panel of 6 ICU nurse experts. Stage II involved assessment of concurrent and construct validity as well as inter-rater reliability of TISS-28 using 105 participants drawn from trauma, cardiothoracic and multidisciplinary ICUs. Data necessary for the calculation of TISS-28, TISS-76 and SAPS II were recorded for each patient in the ICU at 24 and 48 hours after admission and in the wards after discharge within 24 - 48 hours. Descriptive and inferential statistics were used to analyse data. Results. A content validity index (CVI) of 0.93 was found for TISS-28. A significant positive correlation was found between TISS-28 and TISS-76 scores (r=0.7857, p=0.0001). Although the correlation between TISS-28 and SAPS II was significant (p=0.0317), it was small (r=0.2098). A significant intra-class correlation (ICC) was found for the data collected from a sample of patients by the researcher and expert assistant researcher (ICC=0.99; p=0.0001). Conclusions. The findings support the validity and reliability of TISS-28 and hence its feasibility for use in South African ICUs. Recommendations for nursing education, practice, management and research are proposed.

Evaluation of a simplified therapeutic intervention scoring system (TISS-28) and the modified early warning score (MEWS) in predicting physiological deterioration during inter-facility transport

There is an emerging demand for inter-facility transport (IFT) of patients in recent years following changes in the healthcare framework in Hong Kong but this carries certain risks. Anticipation of possible deterioration of patients is important for patient safety and therefore risk stratification of patients before transport is important. This study evaluated the simplified therapeutic intervention scoring system (TISS-28) and modified early warning score (MEWS) in predicting physiological deterioration en route. This is a prospective single centre study of all emergency IFT for adult patients, excluding patients with obstetric conditions, occurring between 1 January 2005 and 30 June 2006. The severity of illness was quantified in terms of TISS-28 and MEWS. Mann-Whitney test and receiver operator characteristic (ROC) curves were used to illustrate and compare their performance. Among 102 patients requiring IFT, 28 had physiological deterioration en route (27%). The TISS-28 scores upon dispatch ranged from 5 to 34 with a mean of 16.5+/-5.71 whereas MEWS ranged from 0 to 11 with a mean of 2.82+/-2.01. The incidence of physiological deterioration en route was significantly greater with a higher MEWS score (P=0.001) but this was not seen with the TISS-28 score. The area under the ROC curve for the predictive value of MEWS was 0.71 which performed better than TISS-28 (area under the curve=0.53). IFT represents a group of patients with vast heterogeneity. TISS-28 is not a useful tool for risk stratification prior to transport. MEWS was able to identify patients at risk but was not ideal.

"Oldest old" patients in intensive care: prognosis and therapeutic activity

In view of ethical considerations and the limited resources in intensive care medicine, the present investigation aims to give a descriptive overview of the prognosis and therapeutic activity for the oldest age group of elderly patients admitted to an intensive care unit (ICU) in comparison with younger ICU patients. 3069 patients admitted to the ICU during a seven-year period were categorized into four age groups: under 65 years (48%), 65 to 74 years (26%), 75 to 85 years (22%) and 85 years or older (5%). Type and reason for ICU admission, length of ICU stay, severity of illness as measured by the simplified acute physiology score (SAPS)-II, level of provided care as measured by the simplified therapeutic intervention scoring system (TISS)-28, and vital status at the date of ICU discharge were recorded. The ICU mortality rate of patients aged 85 years or older was significantly higher than in patients under 65 (OR of mortality: 1.8, p < 0.001). Non-survivors had higher SAPS II levels (even when excluding age points) in all age groups, but higher daily average TISS points only in patients under 85. The daily average TISS score was negatively correlated to age (r = -0.03; p < 0.001) and was significantly lower in the oldest group when compared with all the younger groups (p < 0.001). The oldest patients had a significantly shorter length of stay (median: 2; interquartile range [IQR] 1-3, p < 0.001) than the younger patient groups. Within the very elderly population, age is an important and independent predictor of mortality, but acute severity of illness is even more strongly associated with mortality. Consequently, age alone may be an inappropriate criterion for allocation of ICU resources.

Simplified therapeutic intervention scoring system (TISS 28) to assess intensive care unit (ICU) costs and the efficiency of the admission process to a medical ICU

Simplified therapeutic intervention scoring system (TISS 28) to assess intensive care unit (ICU) costs and the efficiency of the admission process to a medical ICU

Nine equivalents of nursing manpower use score (NEMS).

To develop a simplified Therapeutic Intervention Scoring System (TISS) based on the TISS-28 items and to validate the new score in an independent database. Retrospective statistical analysis of a database and a prospective multicentre study. Development in the database of the Foundation for Research on Intensive Care in Europe with external validation in 64 intensive care units (ICUs) of 11 European countries. Development of NEMS on a random sample of TISS-28 items, cross validation on another random sample of TISS-28, and external validation of NEMS in comparison with TISS-28 scored by two independent raters on the day of the visit to the ICUs participating in an international study. Multivariable regression techniques, Pearson's correlation, and paired sample t-tests were used (significance at p < 0.05 level). Intraclass correlation, rate of agreement, and kappa statistics were used for interrater reliability tests. The TISS-28 items were reduced to NEMS (9 items) in a random sample of 2000 records; the means of the two scores were no different: TISS-28 26.23 +/- 10.38, NEMS 26.19 +/- 9.12, NS. Cross-validation in a random sample of 996 records; mean TISS-28 26.13 +/- 10.38, NEMS 26.17 +/- 9.38, NS; R2 = 0.76. External validation on 369 pairs of TISS-28 and NEMS has shown that the means of the two scores were no different: TISS-28 27.56 +/- 11.03, NEMS 27.02 +/- 8.98, NS; R2 = 0.59. Reliability tests have shown an "almost perfect" interrater correlation. Similar to studies correlating TISS with Simplified Acute Physiology Score (SAPS)-I and/or Acute Physiology and Chronic Health Evaluation II scores, the value of NEMS scored on the first day accounts for 30.4% of the variation of SAPS-II score. NEMS is a suitable therapeutic index to measure nursing workload at the ICU level. The use of NEMS is indicated for: (a) multicentre ICU studies; (b) management purposes in the general (macro) evaluation and comparison of workload at the ICU level; (c) the prediction of workload and planning of nursing staff allocation at the individual patient level.

Validation of the simplified therapeutic intervention scoring system on an independent database.

To evaluate the performance of the Simplified Therapeutic Intervention Scoring System on an independent database and determine its relation with the Therapeutic Intervention Scoring System in the quantification of nursing workload in intensive care. Analysis of the database of a multicenter prospective Portuguese study. 19 intensive care units (ICUs) in Portugal. Data on 1094 patients consecutively admitted to the ICUs were collected during a period of 3 months. Collection of the data necessary for the calculation of the Therapeutic Intervention Scoring System (TISS-76) and the Simplified Therapeutic Intervention Scoring System (TISS-28) during the first 24 h in the ICU. Basic demographic statistics and all the variables necessary for the computation of the Simplified Acute Physiology Score II were also collected. Vital status at discharge from the hospital was registered. Regression techniques, Pearson's correlation and paired sample t-test were used. Results are presented as mean +/- standard deviation except when stated otherwise. Reliability was evaluated by the use of intraclass correlation coefficients in a 5% random sample. After exclusion of all the patients with missing data, 1080 patients were analysed. The overall mean TISS-28 (29.82 +/- 10.64) was significantly lower than the mean TISS-76 (31.14 +/- 11.95). Both systems showed very significant differences between ICUs (p < 0.001). The correlation between the two was good, with TISS-28 explaining 72% of the variation of TISS-76 (r = 0.85, r2 = 0.72). The relation between the two systems was TISS-28 = 6.22 + 0.85 TISS-76. In this cohort, reliability of data collection was very high, with intraclass correlation coefficients greater than 0.90 for both systems. TISS-28 was validated on this independent population. The results indicate that TISS-28 can replace TISS-76 for the measurement of the nursing workload in Portuguese ICUs.