An Updated Therapeutic Intervention Scoring System for Critically Ill Children Enables Nursing Workload Assessment With Insight Into Potential Untoward Events.
BACKGROUND
To introduce an updated version of the original Therapeutic Intervention Scoring System (TISS) applicable to critically ill children (TISS-C). This version was designed to assess patient acuity and nursing workload (NW) and to determine a relationship between such assessment and the incidence of adverse events.


METHODS
Reviewing previous versions of TISS, an updated TISS-C was developed. Items inapplicable to pediatric critical care were eliminated; items current to critical care were added; and items still valid were edited. The point system accounts for the wide range of care provided. Random patients from a predetermined period had TISS-C scores calculated. The TISS-C scores were also calculated on patients with documented adverse events. Baseline scores were compared with scores of patients in whom adverse events had occurred. We determined the pediatric intensive care unit (PICU) NW to be the product of the TISS-C score and the patient-nurse ratio (PNR).


RESULTS
One hundred twenty-five random patients had a mean TISS-C of 14.6 ± 11.8. Patients with any adverse event (98) had a TISS-C of 19.9 ± 11.6 (P < .05). Using our PICU mean PNR of 1.4 (20 patients/14 nurses), the NW for patients with more severe events was 33.6 ± 15.9.


CONCLUSIONS
Critically ill pediatric patients are more vulnerable to experience adverse events when their derived NW values are high. It is postulated that a critical NW exists, where adverse events are more likely to occur.
Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of NY, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA rtrope@nshs.edu.
Randi
R
Trope
Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of NY, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
Sandra
S
Vaz
Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of NY, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
Marcia
M
Zinger
Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of NY, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
Mayer
M
Sagy
D002648:Child; D002675:Child, Preschool; D064648:Critical Care Nursing / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D009741:Nursing Staff, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D062072:Patient Acuity; D012189:Retrospective Studies; D016526:Workload / Q000592:standards* / Q000706:statistics & numerical data
adverse events; nursing workload; outcome assessment; pediatric intensive care; severity of illness