TISS-28 — Therapeutic Intervention Scoring System
Measures ICU nursing workload: TISS-28 scores 28 therapeutic interventions over 24 hours (0–78). One point ≈ 10.6 minutes of nursing time; one nurse can deliver about 46 points per shift (Miranda 1996).
Score interpretation
Cullen class I: does not need intensive care.
→ Ward or step-down level of care.
Cullen class II: observation / high-dependency level of care.
→ HDU or ICU-step care.
Cullen class III: needs intensive care (haemodynamic instability).
→ ICU-level nursing; review the nurse:patient ratio against the workload (~46 points per nurse per shift).
Cullen class IV: unstable patient needing intensive nursing and medical care.
→ 1:1 nursing or more; senior critical care review.
Interpretation bands for the TISS-28. Apply clinical judgement and local guidance.
References
- Miranda DR, de Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System: the TISS-28 items — results from a multicenter study. Crit Care Med. 1996;24(1):64-73.
- Cullen DJ, et al. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med. 1974;2(2):57–60.
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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.