TISS General Info

The Therapeutic Intervention Scoring System (TISS) is a method of quantifying, over a 24 hour period, the intensity of nursing and medical care required by ICU patients. The WRHA Critical Care Program uses a locally modified version of TISS28 which includes 49 therapeutic variables. In addition to the 28 TISS therapeutic variables, our version contains an additional 21 items that our Regional Critical Care Program have included to monitor for QI purposes.

The wording of the specific items on the TISS28 scoring sheet comes directly from those who developed it. It is purposely simplified and repetitive to ensure clear understanding by all.

The completion of TISS scoring benefits both the nurses and the patients in our ICUs.

We will scan all pages for entire LOS in ICU. New form will have 7 days per form. Data will be stored in TISS28 Data.mdb.

TISS28 reflects the care provided to a patient from midnight to midnight on a "calendar date". The wording adaptations on our TISS28 were used to make the form user friendly while maintaining the "spirit" of original article published by R. Miranda et.la. Reasons for wording adaptations are due to 2 things:

1. how nurses are filling the form out (not done midnight looking back previous day) but doing it daily within the 24 hrs of a calendar day.
2. practicality: hard time to explain to a large number of nurses on how we want it done. We want to reduce interpretations as much as possible. - as per final review with Dr. Allan Garland & Jodi Walker Tweed.

Regional ICU Bedside Education Script

see Bedside nurse education for TISS28

TISS Items

TISS Item List - makes list of individual items on our TISS form

Purpose/Use of TISS

see TISS28 data use

History of TISS

• 1974 first introduced 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. Included 70 therapeutic variables. TISS70.
• 1983 modified: with 76 therapeutic variables. TISS76
  • Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: update 1983. Crit Care Med. 1983 Jan;11(1):1-3.
    • A "locally modified" version of the 1983 TISS76 with a list of 83 therapeutic variables has been used at Health Sciences Center (HSC) since July, 1988 & in other ICU's in the Winnipeg Region since 1998 & 1999.
• 1994 modified: for use for intermediate and floor care nursing units iTISS.
• 1996 modified: to reduce and included 28 therapeutic variables. TISS28.

Original article, go to: TISS 28 R.Miranda CritCareMed_1996

• Miranda article on Web Lippincott William _not all tables in article.
• Miranda abstract only - Pubmed
• Rolkf Lefering evaluating ITSS28 in an SICU-abstract only - Pubmed
• J Graf, C Graf, KC Koch, P Hanrath and U Janssens. Cost analysis and outcome prediction with the Therapeutic Intervention Scoring System (TISS and TISS-28). [German]. Medizinische Klinik 98(3):123-132, 2003. ---- this good paper compares TISS76 with TISS28, and showed use of TISS to track ICU costs
• UofM Library: KB Laupland, R Shahpori, AW Kirkpatrick and HT Stelfox

Start Date TISS28

January 1, 2013 @ 0001 hrs for all patients in an ICU's in the region on this date.

TISS28 scoring

TISS elements are weighted from 1-8 points. A total maximum score is 78 points.

• According to this system, each nurse can provide care for 46.35 TISS-28 points per shift, with each TISS-28 point requiring 10.6 minutes of each nurse's shift.

See also

• sfar.org - This is a reference to a web-based version

Legacy Information

See also TISS28 Implementation

Critical Care

A "locally modified" version of the 1983 TISS76 with a list of 83 therapeutic variables has been used at Health Sciences Center (HSC) since July, 1988.

• 5 days of TISS - from June 1988 to mid September 13, 1998, only one page (first 5 ICU days) of TISS76 was scanned and uploaded to master ICU TMSX database.
• 10 days of TISS - started: September 14, 1998 two pages (first 10 ICU days) was scanned and uploaded to master ICU TMSX database.
• Our modified version of TISS76 was as also implemented in all other ICU's within the Winnipeg Regional Health Authority (WRHA) in 1999.
• TISS76 was stopped: December 31, 2012, midnight.

January, 1, 2013 - New TISS28 we will scan all pages for entire LOS in ICU. New form has 7 days per form. TISS28 data will not be uploaded to master TMSX database. It will be stored in an alternate repository called TISS28 Data.mdb.

The WRHA Critical Care Program changed to TISS28 because it takes less effort to collect, compared to the original TISS76 and provides the same level of information required for purposes listed below. Like the original TISS76, TISS28 also does not even come close to including all of the things done by ICU nurses. 76 items is a considerable number, and efforts were made to try and reduce the number of individual items without reducing the validity of the TISS score. In 1996 a careful analysis was done by ( TISS 28 R.Miranda CritCareMed_1996) to reduce the original 76 items to 28 items (TISS-28) Instead, the snapshot of nursing workload represented by the TISS28 score has been demonstrated to correlate with total nursing workload, and with the severity of illness. Since the TISS items are things done by bedside ICU nurses, they are in the best position to accurately identify them.

Medicine

iTISS piloted for Medicine wards. For start and stop dates go to iTISS article.