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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

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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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Literatur

  1. Pandharipande P, Cotton BA, Shintani A, Thompson J, Costabile S, Truman Pun B, Dittus R, Ely EW (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731

    Article  PubMed  Google Scholar 

  2. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962

    Article  PubMed  Google Scholar 

  3. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710

    Article  CAS  PubMed  Google Scholar 

  4. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73

    Article  PubMed  Google Scholar 

  5. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882

    Article  PubMed  Google Scholar 

  6. Zaubler TS, Murphy K, Rizzuto L, Santos R, Skotzko C, Giordano J, Bustami R, Inouye SK (2013) Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital. Psychosomatics 54:219–226

    Article  PubMed  Google Scholar 

  7. Strom T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375:475–480

    Article  PubMed  Google Scholar 

  8. Kratz T, Heinrich M, Schlauß E, Diefenbacher A (2015) Prävention des postoperativen Dellirs. Dtsch Ärztebl Int 112:289–296

    PubMed Central  PubMed  Google Scholar 

  9. Lord RK, Mayhew CR, Korupolu R, Mantheiy EC, Friedman MA, Palmer JB, Needham DM (2013) ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med 41:717–724

    Article  PubMed  Google Scholar 

  10. Lefering R, Zart M, Neugebauer EA (2000) Retrospective evaluation of the simplified Therapeutic Intervention Scoring System (TISS-28) in a surgical intensive care unit. Intensive Care Med 26:1794–1802

    Article  CAS  PubMed  Google Scholar 

  11. Muehler N, Oishi J, Specht M, Rissner F, Reinhart K, Sakr Y (2010) Serial measurement of Therapeutic Intervention Scoring System-28 (TISS-28) in a surgical intensive care unit. J Crit Care 25:620–627

    Article  PubMed  Google Scholar 

  12. Miranda DR, de Rijk A, Schaufeli W (1996) Simplified Therapeutic Intervention Scoring System: the TISS-28 items–results from a multicenter study. Crit Care Med 24:64–73

    Article  CAS  PubMed  Google Scholar 

  13. Guenther U, Weykam J, Andorfer U, Theuerkauf N, Popp J, Ely EW, Putensen C (2012) Implications of objective vs subjective delirium assessment in surgical intensive care patients. Am J Crit Care 21:e12–20

    Article  PubMed  Google Scholar 

  14. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L (2009) Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 13:R77

    Article  PubMed Central  PubMed  Google Scholar 

  15. Reis Miranda D, Moreno R, Iapichino G (1997) Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 23:760–765

    Article  CAS  PubMed  Google Scholar 

  16. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344

    Article  PubMed  Google Scholar 

  17. Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, Putensen C (2010) Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients. J Crit Care 25:144–151

    Article  PubMed  Google Scholar 

  18. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  19. Martin J, Neurohr C, Bauer M, Weiss M, Schleppers A (2008) [Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix]. Anaesthesist 57:505–512

    Article  CAS  PubMed  Google Scholar 

  20. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134

    Article  PubMed  Google Scholar 

  21. Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP (2010) Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 111:451–463

    Article  PubMed  Google Scholar 

  22. Chen CC, Chen CN, Lai IR, Huang GH, Saczynski JS, Inouye SK (2014) Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery. J Am Geriatr Soc 62:261–268

    Article  PubMed Central  PubMed  Google Scholar 

  23. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676

    Article  CAS  PubMed  Google Scholar 

  24. Padilha KG, Sousa RM, Kimura M, Miyadahira AM, da Cruz DA, Vattimo Mde F, Fusco SR, de Campos ME, Mendes EM, Mayor ER (2007) Nursing workload in intensive care units: a study using the Therapeutic Intervention Scoring System-28 (TISS-28). Intensive Crit Care Nurs 23:162–169

    Article  PubMed  Google Scholar 

  25. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864

    Article  CAS  PubMed  Google Scholar 

  26. Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, Heidegger CP, Weiss NS (2009) Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 37:2527–2534

    Article  PubMed  Google Scholar 

  27. Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, Scheidemann M, Putensen C, Popp J (2013) Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg 257:1160–1167

    Article  PubMed  Google Scholar 

  28. Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, Marcantonio ER (2010) Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 58:643–649

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    U. Guenther DESA, EDIC, F. Koegl, N. Theuerkauf, J. Maylahn, U. Andorfer, J. Weykam, T. Muders & C. Putensen

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  1. U. Guenther DESA, EDIC
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  2. F. Koegl
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  4. J. Maylahn
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  5. U. Andorfer
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  6. J. Weykam
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  7. T. Muders
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  8. C. Putensen
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Correspondence to 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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