Therapeutic intervention scoring system (TISS) — a method for measuring workload and calculating costs in the ICU

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Abstract
The Therapeutic Intervention Scoring System (TISS) is an easily applicable method for measurement of workload in the intensive care unit (ICU). In the present study a modified TISS-scoring (mTISS) was performed daily during 1988–1989 on 2693 patients in a general ICU. Of these, 900 could be classified as ‘true’ ICU-patients (ICU-stay ≥ 24 h or TISS ≥ 20 points), whereas the rest were postoperative. In ICU-patients the average length of stay was 4.5 ± 8.9 days and the average workload 114 ± 218 mTISS-points. The workload was not significantly related to age or type of admission (scheduled vs unscheduled). Hospital non-survivors (13.6%) showed a significantly increased mean total mTISS-score (239 ± 364, P<0.001). Critically ill (TISS Class IV) patients (14% of the sample), with an average workload of 437 ± 401 mTISS points, consumed 53% of the total resources. Patients categorized (ICD-9) to respiratory and infectious diseases showed the greatest average workload (207 ± 315 and 208 ± 355 mTISS-points, respectively). A workload-index was also developed relating the actual workload to the ICU personnel. The cost of each mTISS-point was calculated. In conclusion, the present study showed that mTISS is a valuable tool when evaluating resource utilization in the ICU. Together with the proposed workload-index and calculation of costs, mTISS could be used for ICU management control.