Intermediate TISS

We developed Intermediate TISS (Cujlen.. 1994) to focus on class I patients who, by definition, do not require ICU facilities. Patients believed to be at high risk of developing serious postoperative problems, although not needing intensive care perse, are often admitted to the ICU for overnight observation. Similarly, patients are often admitted to medical ICUs or coronary care units to exclude myocardial infarction. Thus we wish to improve identification of medical patients who may not require intensive therapies, but nevertheless need cardiopulmonary monitoring.

Intermediate TISS could also be used to determine the need for additional hospital facilities such as more ICU beds, intermediate care areas, or bedside flexible monitoring. Cost containment may limit or halt the growth of ICU facilities, as less expensive ways of caring for patients are developed. Therefore we modified TISS for intermediate and floor care to emphasize both the medical and surgical aspects of a patient's illness. Intermediate TISS focuses on medical patients with cardiopulmonary problems and diabetes mellitus. Although many of these medical problems could be managed more easily in an ICU, they are increasingly being managed outside the ICU, which is both time-consuming and task intensive for a general care nurse. One criticism of the original TISS was that it was too procedurally oriented and diminished the importance of nursing care. Some of the items added or upweighted for Intermediate TISS recognize the increased nursing effort required for appropriate care of medical patients in the absence of specific procedures. Intermediate TISS can be substituted for the original TISS when assessing the hospital's needs for intermediate care, flexible monitoring, or floor care.

Intermediate TISS adds useful new information for defining the severity of illness in medical patients or surgical patients with medical complications, but does not add significantly to the original TISS for surgical patients ( CuNen §i.§L 1994).

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