Intermediate TISS: a new Therapeutic Intervention Scoring System for non-ICU patients.

Objective: To modify the Therapeutic Intervention Scoring System (TISS) for intermediate and floor care nursing units.

Design: Prospective study.

Setting: University teaching hospital.

Patients: In-patients on medical and surgical nursing units.

Interventions: None.

Measurements And Main Results: Intermediate TISS retains 49 Original TISS items, adds 26 Intermediate TISS items, deletes 18 Original TISS items, and reweights 10 Original TISS items. Intermediate TISS score sums up the monitoring and therapeutic modalities used within the previous 24 hrs, each of which is assigned a weighted score from 1 to 4 points. A total of 3,073 patient days for 1,013 patients were simultaneously scored for Original TISS and Intermediate TISS over a 4-month period. A random sample of 435 patients was examined to identify those patients for whom Intermediate TISS added information over and above that obtained from Original TISS. Original TISS and Intermediate TISS correlated well, regression equation: Intermediate TISS = 4.4 + 1.4 x Original TISS (r2 = .83). We identified two groups of outliers, together constituting 96 of 435 patients: a) patients whose sum of new TISS items was unusually high relative to the sum of old TISS items included those patients with diabetes mellitus, those patients receiving serial electrocardiograms to rule out myocardial infarction and patients requiring cardiac or pulmonary therapy; b) those patients whose sum of new TISS items was low relative to the sum of old TISS items were largely surgical patients outside the intensive care unit (ICU), in whom Original TISS still worked well because it had been designed for surgical ICU patients.

Conclusions: Intermediate TISS is useful to score medical patients receiving intermediate or floor care in non-ICU nursing units within the hospital.