TISS28 data use

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The statistician reports TISS results as part of various projects (both recurring and special). This article provides background information on the TISS data, including how it gets transformed from its raw state, i.e., as exported from Teleform, to a structure that is usable for reporting and/or viewing to support current and future projects.

TISS is the only tool we have at present to quantify objectively, the nursing care that is done in ICU's. It is a widely accepted and validated method of classifying critically ill patients which is used for a number of purposes:

  1. Expresses nursing work activities in statistical terms (nursing workload).
  2. Establishing nurse-patient ratios in the ICU (matching ICU nurse staffing to ICU needs)
    • As the nursing staff are the largest economic investment in an ICU, measuring nursing workload in different ICUs from different centres can contribute to the estimation of nursing staff required according to the specific demands of the units.
  3. Assessing current utilization of ICU beds
  4. Establishing future needs and numbers of ICU beds
  5. Determining severity of illness
    • Since the intensity of ICU interventions is related to severity of illness, the TISS score is related to outcomes such as length-of-stay and mortality
      • NOTE: the capability with determining severity of illness with TISS has lost its application with the appearance of more specific scoring systems in the 1980 namely APACHE.
  6. our TISS also contains elements that assist with quality reviews and provide information about resource utilization which is used by: WRHA Nursing & Medical Administrators, CCVSM & ICU QI Team & Researchers.

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.

Where TISS data is used

  • The Therapeutic Intervention Scoring System - See: TISS General Info article for general information.
    • is reported as an indicator to quantify the nursing and medical care being given to a critically ill patient in ICU.

In the Critical Care periodic reports, 35 TISS76-Points per day is being used to correspond to the work of one nurse per shift. The TISS data are used by the Critical Care Directors to compare nursing manpower between groups of patients or units in the region. The data derived from TISS are:

    • Total TISS score per patient
    • TISS per patient day = Sum of all patient's TISS Scores divided by the product of the Number of Calendar Days and Average Daily Bed Occupancy.
    • TISS predicted RN = Sum of all patient's TISS Scores divided by the product of the Number of Calendar Days and 35.
  • TISS Score is also used as a method of classifying critically ill patients and thus being used by physicians/investigators in their research projects. Aside from the Total Score per patient, Day1 TISS Score, Day2 TISS Score, Last Day TISS Score or nth Day TISS Score are also of interest to the investigators. The Critical Care Administrative Director is also monitoring the bottom 4 TISS Scores per calendar date for administrative purposes.
  • The individual TISS elements are also being used as part of interfacility transfer/severity of illness/quality indicators. The data required maybe the:
  1. total patient count having the TISS element present and/or
  2. the number of days the TISS element is present per patient.

Some TISS elements are reported on a regular basis while others are being requested as needed by Critical Care Directors/Managers/ Physicians/Investigators. The TISS elements currently used in regular reports and continuing projects (e.g. CCVSM, ICU QI, OIT, Complications Monitoring, Interfacility Transfers) are: