Abstract
Variability in workload in a Pediatric ICU (PICU) often results in the reassignment of nursing staff to or from other patient care areas. Inability to predict whether they will have adequate help or be reassigned is a s.ource of stress for PICU nurses. Thus, both increases and decreases in workload are stressful. The Therapeutic Intervention Scoring System (TISS) quantitates ICU nursing care and has been used as a measure of staffing needs (Polachek: Crit Care Med 1986;14:417). We asked whether patient census adequately reflects unit total (UT) TISS points as a measure of daily variability in nursing workload.
Data were collected over 12 months from October 1985 through September 1986 in a medical/surgical PICU. A total of 3,133 patient-days of care were rendered with a median daily census of 9 (range 2-12) patients. A total of 58,352 TISS points were recorded with a median TISS points per patient-day of 16 (range 3-78) and a median daily UT-TISS of 160 (range 26-305) points. The medians for absolute change over 1-day were 1 (range 0-5) patient, and 20 (range 0-110) UT-TISS points.
The relationship between 1-day change in census and 1-day change in UT-TISS was described by the regression equation: Δ UT-TISS = 14.6 (Δ Census) - 0.1, SEE 24.4, r = 0.68. Thus, only 46% of change in UT-TISS could be explained by a change in census. This invalidated census as an index of workload, and emphasized the need for objective measurement of therapeutic intensity when considering nursing reassignment.
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Mickell, J., Lucking, S. DAILY VARIABILITY IN ICU NURSING WORKLOAD: CHANGE IN CENSUS VERSUS CHANGE IN THERAPEUTIC INTENSITY LEVEL. Pediatr Res 21 (Suppl 4), 204 (1987). https://doi.org/10.1203/00006450-198704010-00228
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DOI: https://doi.org/10.1203/00006450-198704010-00228