Pflegeaufwandsindizes TISS-10, TISS-28 und NEMS

Erhöhter Arbeitsaufwand bei Agitation und Delir wird nicht erfasst

Nursing workload indices TISS-10, TISS-28, and NEMS

Higher workload with agitation and delirium is not reflected

Zusammenfassung

Hintergrund

Mittelzuweisungen zu pflegeintensiven Patienten auf der Intensivstation geschehen im Rahmen des Diagnosis-related-groups(DRG)-Systems v. a. über das Therapeutic Intervention Scoring System 10 (TISS-10). TISS-10 wurde nie validiert. Die vorliegende Analyse prüfte, ob Delir und Agitation auf der Intensivstation von den gängigen Pflegeaufwandsindizes TISS-10, TISS-28 und 'Nine Equivalents of Nursing Manpower' (NEMS) überhaupt erfasst werden. Sekundäre Ziele waren, inwiefern die Indizes korrelieren und welche Effekte Delir und Agitation auf die Erlössituation hatten.

Material und Methoden

Ausgewertet wurden retrospektiv 521 Datensätze von 152 Patienten. Der Pflegeaufwand wurde mit TISS-28, TISS-10 und NEMS erfasst, Delir mit der Confusion Assessment Method for Intensive Care Units (CAM-ICU) und Agitation mit der Richmond Agitation–Sedation Scale (RASS). Kosten und Erlöse wurden anhand des Patientendatenmanagementsystems und des Budgetkalkulationstools 2007 der Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI) errechnet.

Ergebnisse

Ein Delir hatten 36,2 % der Patienten (n = 55). Die Indizes TISS-28, TISS-10 und NEMS waren bei Delir nicht erhöht, wenn für Beatmung (ja/nein) korrigiert wurde. TISS-28, TISS-10 und NEMS waren signifikant höher bei tief sedierten und komatösen (RASS ≤ − 3, p < 0,001), aber nicht bei agitierten (RASS ≥ 1) und flacher sedierten Patienten (RASS − 1/− 2). TISS-10 und TISS-28 korrelierten linear (r 2 = 0,864). Die medianen Bilanzen der Intensiverlöse waren insgesamt negativ, aber mit Delir wesentlich ausgeprägter als ohne Delir (− 3174 € mit Delir vs. − 1721 € ohne Delir, p = 0,0147).

Schlussfolgerung

Die Standardpflegeaufwandsindizes (TISS-10, TISS-28, NEMS) reflektieren nicht den täglichen höheren Arbeitsaufwand bei Patienten mit Delir oder Agitation.

Abstract

Background

Financial resources for the treatment of ICU patients requiring high nursing workload are allocated within the German diagnostic-related groups (DRG) system in part through the Therapeutic Intervention Scoring System-10 (TISS-10). TISS-10, however, has never been validated. This study evaluated whether delirium and agitation in ICU were reflected by TISS-10, and also by the established workload indices TISS-28 and Nine Equivalents of Nursing Manpower (NEMS). Secondary aims were if indices correlated, and what effects delirium and agitation had on financial balances.

Materials and methods

Analyses were performed retrospectively in 521 datasets from 152 patients. Nursing workload was assessed with TISS-28, TISS-10, and NEMS, delirium with the Confusion Assessment Method for Intensive Care Units (CAM-ICU), and vigilance with the Richmond Agitation–Sedation Scale (RASS). Revenues were retrieved from the institution’s patient data management system, and costs calculated with the Budget Calculation Tool 2007 provided by the German Society of Anaesthesiologists.

Results

Delirium was found in 36.2 % of patients (n = 55). TISS-28, TISS-10, and NEMS were not higher in patients with delirium, if corrected for mechanical ventilation. TISS-28, TISS-10, and NEMS were significantly higher in deeply sedated and comatose patients (RASS ≤ − 3, p < 0.001), but not in agitated (RASS ≥ 1) and lightly sedated patients (RASS − 1/− 2). TISS-10 and TISS-28 had a linear correlation (r 2 = 0.864). Median financial balances were negative, but much more pronounced in patients with delirium that without (− 3174 € with delirium vs. − 1721 € without delirium, p = 0.0147).

Conclusion

The standard workload-scores (TISS-10, TISS-28, NEMS) do not reflect higher daily workload associated with patients with delirium and agitation.

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Correspondence to PD Dr. U. Guenther DESA, EDIC.

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U. Guenther, F. Koegl, N. Theuerkauf, J. Maylahn, U. Andorfer, J.Weykam, T. Muders, C. Putensen geben an, dass kein Interessenkonflikt besteht.

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Guenther, U., Koegl, F., Theuerkauf, N. et al. Pflegeaufwandsindizes TISS-10, TISS-28 und NEMS. Med Klin Intensivmed Notfmed 111, 57–64 (2016). https://doi.org/10.1007/s00063-015-0056-5

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Schlüsselwörter

  • Verwirrtheit
  • Unruhe
  • Krankenpflege
  • Scoringmethoden
  • Kosten und Kostenanalyse

Keywords

  • Confusion
  • Restlessness
  • Nursing
  • Scoring methods
  • Costs and cost analysis