Serial measurement of Therapeutic Intervention Scoring System-28 (TISS-28) in a surgical intensive care unit.
ABSTRACT The aim of the study was to assess the use of the Therapeutic Intervention Scoring System-28 (TISS-28) in surgical intensive care unit (ICU) patients and the relationship of the score to the type of surgery, severity of illness, and outcome in these patients.
Prospectively collected data from all patients admitted to a postoperative ICU between March 1, 2004, and June 30, 2006, were analyzed retrospectively.
A total of 6903 patients were admitted during the study period (63.5% male; mean age, 62.3 years) constituting 29 140 observation days. The mean Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), and TISS-28 scores on the day of ICU admission were 36.9 ± 18.2, 5.8 ± 3.9, and 43.2 ± 10.8, respectively. The highest admission TISS-28 was observed in patients who underwent cardiothoracic surgery (47.7 ± 10.1), the lowest in neurosurgical patients (40 ± 9.6), and both declined during the 2 weeks after ICU admission; however, in trauma patients and those admitted after gastrointestinal surgery, TISS scores increased gradually after the first 2 to 5 days in the ICU. The TISS-28 score was moderately correlated to SAPS II (R(2) = 0.42; P < .001) and SOFA score (R(2) = 0.48; P < .001) throughout the ICU stay and was consistently higher in nonsurvivors than in survivors during the first 2 weeks in the ICU.
There are marked variations in TISS-28 scores according to the type of surgery. Therapeutic Intervention Scoring System-28 correlates with the severity of illness and outcome in these patients.
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ABSTRACT: INTRODUCTION: The physiological basis of physiotherapeutic interventions used in intensive care have been established. There is a need to determine the optimal service approach which will result in improved patient outcome. The aim of this paper is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared to usual-care on patient outcomes. METHODS: An exploratory, controlled, pragmatic, sequential time block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol-care (3 weeks) and usual-care (3 weeks) was provided consecutively over two six week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data was analyzed with Statistica in consultation with statistician. Where indicated relative risks with 95% CI are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported p-values are two-sided. Results Data of 193 admissions were analyzed. There was no difference noted between the two patient groups at baseline. Patients admitted to the unit during protocol-care were less likely to be intubated after unit admission (RR 0.16 95%CI 0.07 - 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail an extubation (RR 0.23 95%CI 0.05 - 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95%CI 0.65 - 3.35) TISS-28 units (p=0.04). Protocol-care patients were discharged from the hospital four days earlier than usual-care patients (p=0.05). There was a tendency noted for more patients to reach independence in the transfers (p=0.07) and mobility (0=0.09) categories of the Barthel Index. CONCLUSIONS: A physiotherapy service approach which includes an exclusively allocated physiotherapist providing evidence-based/protocol care which addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost effective service approach to care than usual-care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multi-centre randomized controlled trial. Trial registration: PACTR201206000389290.Critical care (London, England) 12/2012; 16(6):R230. · 4.72 Impact Factor
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ABSTRACT: Objective: To assess the performance of the Nursing Activities Score in a pediatric intensive care unit, compare its scores expressed as time spent on nursing activities to the corresponding ones calculated using the Simplified Therapeutic Intervention Scoring System, and correlate the results obtained by both instruments with severity, morbidity and mortality. Methods: Prospective, observational, and analytical cohort study conducted at a type III general pediatric intensive care unit. The study participants were all the children aged 29 days to 12 years admitted to the investigated pediatric intensive care unit from August 2008 to February 2009. Results: A total of 545 patients were studied, which corresponded to 2,951 assessments. The average score of the Simplified Therapeutic Intervention Scoring System was 28.79±10.37 (915±330 minutes), and that of the Nursing Activities Score was 55.6±11.82 (802±161 minutes). The number of minutes that resulted from the conversion of the Simplified Therapeutic Intervention Scoring System score was higher compared to that resulting from the Nursing Activities Score for all the assessments (p<0.001). The correlation between the instruments was significant, direct, positive, and moderate (R=0.564). Conclusions: The agreement between the investigated instruments was satisfactory, and both instruments also exhibited satisfactory discrimination of mortality; for that purpose, the best cutoff point was 16 nursing hours/patient day.Revista brasileira de terapia intensiva. 03/2014; 26(1):36-43.
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ABSTRACT: Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation) and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours), that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ (2) = 16945.8,P < 0.001 between the nurses' workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.BioMed research international. 01/2013; 2013:463153.