TISS General Info

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The Therapeutic Intervention Scoring System (TISS) is a method of quantifying over a 24 hrs period, nursing and medical care required by ICU patients.

On January 1, 2013 0001 hours, WRHA, Critical Care Program is targeting change to locally modified version of TISS28 with 49 therapeutic variables. Besides the 28 TISS items, our version contains an additional 21 items that the Critical Care Program includes for QI purposes.

The WRHA Critical Care Program is changing 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 ( R.Miranda CritCareMed1996) to reduced the original 76items 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.

Purpose/Use of TISS

TISS 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 (workload)
  2. Establishing nurse-patient ratios in the ICU (matching ICU staffing to ICU needs)
  3. Assessing current utilization of ICU beds
  4. Establishing future needs and numbers of ICU beds
  5. Determining severity of illness
    • NOTE: this capability of 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.


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

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.
  • 1994 modified: for use for intermediate and floor care nursing units iTISS.
  • 1996 modified: to reduce and included 28 therapeutic variables. TISS28.

below to be incorporated into existing article above

GENERAL INFORMATION TISS stands for the Therapeutic Intervention Scoring System. It was first devised in 1974 as a measure of the intensity of interventions provided to ICU patients by their bedside nurses. The original version was called TISS-76 because it included 76 specific interventions. 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. Even though the 76 interventions are only representative of the much larger number of different things that ICU nurses do for their patients, from the beginning TISS was recognized as being a useful measure of nursing workload, and was used throughout the world (including in the WRHA) to assist in deciding how many nurses were needed to staff an ICU. However, 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 reduced the original 76 items to 28 items (TISS-28). TISS-28 does not even come close to including all of the things done by ICU nurses. Instead, the snapshot of nursing workload represented by the TISS-28 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. We are changing to TISS-28 because it takes less effort to collect, compared to the original TISS-76. The TISS score is incorporated into the Winnipeg ICU Database that has been in existence since 1988. The wording of the specific items on the TISS-28 scoring sheet comes directly from those who developed it. It is purposely simplified and repetitive to ensure clear understanding by all. The current form includes TISS-28 and also contains elements that assist with quality reviews and provide information about resource utilization. Here in the WRHA our nursing administration uses TISS to assess nursing workload, for the purpose of matching ICU staffing to ICU needs. TISS is the only tool we have at present to quantify the nursing care that is done in ICUs. Also, the items are tracked for purposes of assessing and improving quality of care. Thus, completion of TISS scoring benefits both the nurses and the patients in our ICUs. -submitted by Laura & Allan Garland.Trish Ostryzniuk 00:04, 2012 November 8 (EST)

Legacy

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.

  • From about June 1988 to mid September 1998, only one page (pts first 5 ICU days) of TISS76 was scanned and uploaded to master ICU TMSX database. Mid Sept 1998, we started to scan and upload two pages (pts first 10 ICU days) in master ICU TMSX database.
  • Our version of TISS76 was as also implemented in all other ICU's within the Winnipeg Regional Health Authority (WRHA) in 1999. Stop date of this version will be December 31, 2012, midnight.

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

Medicine

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

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