TISS and mortality after discharge from intensive care

Smith, Lincoln; Orts, C. M.; O'Neil, I.; Batchelor, Anna; Gascoigne, A.; Baudouin, Simon

doi:10.1007/s001340051012

Cited by 78 publications

(46 citation statements)

References 28 publications

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“…Recently Smith et al [7] analyzed 238 patients discharged alive from the ICU to in-hospital wards. They found that high Therapeutic Intervention Scoring System (TISS) [15] levels on discharge from the ICU were associated with an increased risk of in-hospital mortality, with mortality rates ranging from 7.3 % in patients with a predischarge TISS lower than 10, to 21.4 % in those with a predischarge TISS greater than 19.…”

Section: Discussionmentioning

confidence: 99%

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

Moreno¹,

Miranda

Matos³

et al. 2001

Intensive Care Med

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IntroductionA significant number of critical ill patients die in the hospital after discharge from the intensive care unit (ICU). Data on this so-called occult mortality, well known since the 1980s, vary significantly between series. Examples include the GiViTI study with 26 % of deaths occurring after ICU discharge [1], the Portuguese study (23 %) [2], the EURICUS-I study (31 %) [3], and the North Thames study (27 %) Results: Those who died in the hospital after ICU discharge had a higher SAPS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure was higher (admission, maximum, and delta SOFA scores). They required more nursing workload resources while in the ICU. Both the amount of organ dysfunction/failure (especially cardiovascular, neurological, renal, and respiratory) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/failure were especially prognostic factors at ICU discharge. Multivariate analysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge probably reflects only the underlying organ dysfunction/failure. Conclusions: It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.

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Section: Discussionmentioning

confidence: 99%

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

Moreno¹,

Miranda

Matos³

et al. 2001

Intensive Care Med

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“…Currently, there are hardly any systematic studies of how daily severity of illness score changes from admission to initial discharge predict ICU readmission [32,52] . Besides the severity of illness score, there is also an association between nursing workload and post-ICU mortality [65,66] . The Therapeutic Intervention Scoring System (TISS) has been widely applied to assess workload and resource allocation in intensive care, measuring treatment intensity [67][68][69] .…”

Section: Readmission?mentioning

confidence: 99%

“…Consequently, attempts have been made to use TISS scores to categorize the level of care that patients require and even to evaluate the care required after ICU discharge [1,68] . Several authors have shown an association of the TISS value of the last ICU day with post-ICU mortality [65,66,69,70] and therefore indirectly the association with ICU readmission. Smith et al [66] concluded in their research that the mean TISS scores in patients readmitted to the ICU were significantly higher than in patients who did not require readmission [65,66] .…”

Section: Readmission?mentioning

confidence: 99%

“…Several authors have shown an association of the TISS value of the last ICU day with post-ICU mortality [65,66,69,70] and therefore indirectly the association with ICU readmission. Smith et al [66] concluded in their research that the mean TISS scores in patients readmitted to the ICU were significantly higher than in patients who did not require readmission [65,66] . For a couple of years, Spanish physicians have shown great interest in this topic and developed the Sabadell score system, a modification of the McCabe score [71][72][73] .…”

Section: Readmission?mentioning

confidence: 99%

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Intensive care performance: How should we monitor performance in the future?

Timmers¹

2014

WJCCM

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Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e. , cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit (ICU) performance are discussed: (1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations; (2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and (3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Intensive care performance; Quality of care; Critical care; Intensive care medicine Core tip: Variations in case mix, intensive care unit (ICU) demographics, clinical and non-clinical factors not addressed by the present severity of illness scores must be quantified to improve the accuracy of future prediction models. A completely different benefit using health-related quality of life (HrQoL) as a performance benchmark could be the follow-up evaluation of the patient's health status after ICU or hospital discharge. The moment when outcome research can predict the short-term (ICU discharge) QoL of a critically ill patient during the first 24 h of ICU admission will give physicians and health care policy makers an up-to-date and reliable evaluation of quality of care in the ICU for the future.Timmers TK, Verhofstad MHJ, Moons KGM, Leenen LPH. Intensive care performance: How should we monitor performance in the future? World J Crit Care Med 2014; 3(4): 74-79 Available from:

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“…Quality of care differences and higher order interactions within ICUs are not captured in simple regression statistical models. For example, quality issues such as night-time discharges [17] and level of support prior to discharge [18] have been shown to affect outcome. Such differences influence hospital mortality, and if not included in the prediction model tend to degrade its performance.…”

Section: Discriminationmentioning

confidence: 99%

Uncertainty and scoring systems

Ridley

2002

Anaesthesia

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Summary Estimating risks for individual patients facilitates communication with patients, relatives and colleagues, and determines whether further treatment is futile. The process of estimating risks involves mathematics (i.e. scoring systems) and human experience and expertise. Understanding how risks are estimated is important because prognostication is an integral part of any medical specialty. In the USA, such treatment limitation or withdrawal decisions were made on only 7% of all intensive care unit patients but this represented 47% of all deaths on such units. In the UK, data reported by the Intensive Care National Audit and Research Centre suggest that although treatment limitation decisions are made on only 11.8% of patients, this accounts for over 50% of deaths on intensive care. Scoring systems offer a useful adjunct in identifying futility but there are important inherent weaknesses that limit their performance. This review aims to discuss some of these limitations.

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TISS and mortality after discharge from intensive care

Abstract: In a hospital without HDU facilities, patients who are receiving HDU levels of care on discharge from the ICU have a high in-hospital mortality.

Cited by 78 publications

References 28 publications

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

Intensive care performance: How should we monitor performance in the future?

Uncertainty and scoring systems

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