TISS

Therapeutic Intervention Scoring System

Background

• First introduced in 1974 by Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic scoring systems: A method of quantitative comparison of patient care. Crit Care Med 2:57-60, 1974) at the Massachusetts General Hospital. (TISS with 70 therapeutic variables).

• Modified in 1983. (TISS with 76 therapeutic variables).
• Modified version in 1994 for use for intermediate and floor care nursing units (iTISS).
• Modified version in 1996. (TISS with 28 therapeutic variables).

• ICU in the City of Winnipeg uses a locally modified version of the 1983 TISS-76 and has a list of 83 therapeutic variables.

• TISS is a method of quantifying nursing and medical care required by ICU patients
• TISS has become a widely accepted and validated method of classifying critically ill patients.

Use

• TISS is utilized in the USA, Canada and abroad for many purposes:
  1. Determining severity of illness (NOTE: this capability of TISS has lost its application with the appearance of more specific scoring systems in the 1980).
  2. Establishing nurse-patient ratios in the ICU
  3. Assessing current utilization of ICU beds
  4. Establishing future needs and numbers of ICU beds
  5. Expresses work activities in statistical terms.

• TISS has been incorporated as an integral part of the Acute Physiologic and Chronic Health Evaluation APACHE II

• The comparative scores of TISS and APACHE enables us to see trends in the type of nursing care (TISS) provided for certain acuity levels (APACHE), for a specific type of diagnosis.

• Reviewing both scores can help determine whether certain nursing activities can be redirected or standardized in certain types of critically ill patients without affecting patient mortality or morbidity.

Scoring

• Each of the most common ICU nursing activities is weighted from 1 to 4 point. More points indicate that greater nursing management is required.

• A high daily TISS score indicates an increase in nursing workload.

Also see:

• TISS mutually exclusive items
• TISS 2 hour rule
• TISS 48 hour rule
• TISS Neurological
• TISS Cardiovascular
• TISS Blood Products
• TISS Respiratory
• TISS Gastrointestinal
• TISS Genitourinary
• TISS Fluid Lytes bloodsample
• TISS Meds_IVs
• TISS General Care
• TISS Procedures Interventions
• TISS Legacy

Discussion

• As LKolesar points out, there is variation in how the TISS is collected in different centers. Is this something we should look at? Ttenbergen 00:04, 27 May 2008 (CDT)