Use of TISS to evaluate ICU bed needs

A very important use of TISS is the accurate determination of a hospital's need for ICU beds. The following questions must be answered.

1. How are the ICU facilities currently being utilized?

2. How many additional beds are needed, and in what type of facility should they be located (postanesthetic care unit, intermediate care, or full intensive care)?

3. Were adverse results reported in patients who were denied intensive care because of inadequate bed supply?

We determined the need for intensive care and used the TISS system to follow patients who were triaged from the ICU. This study, which was performed for our own hospital, led us to design methods to evaluate ICU bed needs in other hospitals prior to obtaining a Certificate of Need for additional ICU beds ( Culleln...andl...Nem®SkaI.. 1989). These data allow us to suggest a nurse-to-patient ratio based on the severity of illness, to determine if patients are being discharged from the ICU earlier than is acceptable based on their TISS points at the time of discharge and in the follow-up period, to decide if any patients did not need intensive care based on their low admission and in-unit TISS points, and to suggest how many ICU beds are needed to manage each unit's case load.

In Table.3 an extremely busy and overloaded surgical ICU is contrasted with a surgical ICU where there is unnecessary admission and retention of patients is occurring.

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Table 3 Comparison of two surgical ICUs (excluding cardiac surgical patients)

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