TISS-28 (Therapeutic Intervention Scoring System)
Daily ICU nursing workload from 28 therapeutic activities
- LKF intensive-care classification (TISS-28)
- Derived in 22 Dutch ICUs
Sources last checked: 2026-10-13
TISS-28 (Therapeutic Intervention Scoring System)
Daily ICU nursing workload from 28 therapeutic activities
Score the activities actually performed during the past 24 hours, not the severity of illness. Austrian ICUs document the TISS-A, which XDok automatically maps to TISS-28 for the LKF classification; the LKF thresholds (Stufe I ≥ 22, II ≥ 27, III ≥ 32) apply to the unit's mean over all ICU days, not to a single patient-day. The workload bands are derived from Miranda's 10.6 min/point and 46 points/shift and are approximate.
Interpretation
| < 24 — less than half of one nurse's shift | With 1 point ≈ 10.6 min and ≈ 46 points per nurse per 8-hour shift (Miranda 1996), the patient needs less than half of one nurse's working time. |
|---|---|
| 24–45 — half to one nurse per shift | Roughly 1 nurse for 1–2 patients at this workload (≈ 46 points per nurse per shift). |
| ≥ 46 — at least one nurse per shift | Workload at or above one nurse's full shift capacity (≈ 46.35 points); 1 : 1 nursing or more. |
What is the TISS-28 (Therapeutic Intervention Scoring System)?
TISS-28 measures nursing workload in the ICU by scoring 28 therapeutic and nursing activities performed in the past 24 hours. Miranda, de Rijk and Schaufeli simplified the original 76-item TISS in 22 Dutch ICUs (Crit Care Med 1996); one point corresponds to about 10.6 minutes of a nurse's 8-hour shift. In Austria, the TISS-28 mean of a unit determines its LKF intensive-care classification (Stufe I–III) and daily supplementary points.
When to use it
- Daily documentation of nursing and therapeutic workload in adult ICUs.
- Staff planning: estimating how many nurses a group of patients requires.
- Understanding the Austrian LKF intensive-care classification, which is based on unit TISS-28 means.
- Comparing workload between units or over time.
When not to use it
- As a measure of severity of illness or prognosis (use SAPS 3 or SOFA).
- To score a single intervention retrospectively without the full 24-hour record.
- Neonatal and paediatric ICUs in Austria, which are classified without the TISS-based documentation.
How it is calculated
| Criterion | Points |
|---|---|
| Standard monitoring (hourly vital signs, fluid balance) | +5 |
| Laboratory (biochemical and microbiological investigations) | +1 |
| Medication | |
| None | 0 |
| Single medication, any route | 2 |
| Multiple intravenous medications | 3 |
| Routine dressing changes (decubitus care/prevention, daily dressing) | +1 |
| Frequent dressing changes (≥ once per shift) and/or extensive wound care | +1 |
| Care of drains (all except gastric tube) | +3 |
| Ventilatory support | |
| None | 0 |
| Supplementary support (spontaneous breathing via tube without PEEP, or oxygen by any method) | 2 |
| Mechanical or assisted ventilation (incl. spontaneous breathing with PEEP) | 5 |
| Care of artificial airway (endotracheal tube or tracheostomy) | +1 |
| Treatment to improve lung function (chest physiotherapy, incentive spirometry, inhalation, suctioning) | +1 |
| Vasoactive medication | |
| None | 0 |
| Single vasoactive drug | 3 |
| More than one vasoactive drug | 4 |
| IV replacement of large fluid losses (> 3 L/m²/day) | +4 |
| Peripheral arterial catheter | +5 |
| Left atrial monitoring / pulmonary artery catheter | +8 |
| Central venous line | +2 |
| Cardiopulmonary resuscitation in the past 24 h (not a single precordial thump) | +3 |
| Haemofiltration or dialysis | +3 |
| Quantitative urine output measurement | +2 |
| Active diuresis (e.g. furosemide > 0.5 mg/kg/day for fluid overload) | +3 |
| Intracranial pressure measurement | +4 |
| Treatment of complicated metabolic acidosis/alkalosis | +4 |
| Intravenous hyperalimentation (parenteral nutrition) | +3 |
| Enteral feeding (gastric tube or other GI route) | +2 |
| Specific interventions in the ICU (e.g. intubation, pacemaker, cardioversion, endoscopy, emergency surgery, gastric lavage) | |
| None | 0 |
| Single | 3 |
| Multiple | 5 |
| Specific intervention outside the ICU (surgery or diagnostic procedure) | +5 |
TISS-28 = sum of points for activities in the past 24 h (max. 78) Nursing time ≈ TISS-28 × 10.6 min; one nurse ≈ 46 points per 8-hour shift
Clinical pearls and limitations
- Score the activities actually performed during the past 24 hours, not the severity of illness. Austrian ICUs document the TISS-A, which XDok automatically maps to TISS-28 for the LKF classification; the LKF thresholds (Stufe I ≥ 22, II ≥ 27, III ≥ 32) apply to the unit's mean over all ICU days, not to a single patient-day. The workload bands are derived from Miranda's 10.6 min/point and 46 points/shift and are approximate.
- Four pairs are mutually exclusive: single vs multiple medication, supplementary vs mechanical ventilation, single vs multiple vasoactive drugs, single vs multiple ICU interventions.
- Routine and frequent dressing changes can both be scored on the same day.
- Routine radiographs, ECG, echocardiography and line insertions are not 'specific interventions'.
- LKF thresholds (mean TISS-28 ≥ 22 / ≥ 27 / ≥ 32 for Stufe I / II / III) refer to the average over all ICU days, together with nurse-to-bed ratios.
- Austria documents TISS-A, which adds items such as ECMO and delirium care; the ministry's software maps it to TISS-28 for the LKF.
Frequently asked questions
How many TISS-28 points can one nurse handle?
Miranda 1996 found that a nurse delivers about 46 TISS-28 points per shift (1 point ≈ 10.6 minutes).
What is the maximum TISS-28 score?
78 points when every non-exclusive item and the higher option of each exclusive pair is scored; real patients rarely exceed 50–60.
What TISS-28 is needed for an intensive-care unit in Austria?
For the LKF classification, a unit's mean TISS-28 must be ≥ 22 for Intensivbehandlung Stufe I, ≥ 27 for Stufe II and ≥ 32 for Stufe III, plus minimum nurse-to-bed ratios.
What is the difference between TISS-28 and TISS-A?
TISS-A is the Austrian documentation version used since 2012 with additional items; for financing it is converted back to TISS-28.
Evidence and guidelines
- Primary source: 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.
- SFAR (Société Française d'Anesthésie et de Réanimation) — TISS-28 item table with point weights, definitions and exclusion rules.
- Moreno R, Morais P. Validation of the simplified therapeutic intervention scoring system on an independent database. Intensive Care Med 1997;23(6):640-644.
- BMASGPK. LKF-Modell für den stationären Bereich — Kap. Intensiveinheiten: Einstufung nach dem TISS-28-Mittelwert (Intensivbehandlung Stufe I ≥ 22, II ≥ 27, III ≥ 32 Punkte), Dokumentation mit TISS-A und SAPS3.
- BMASGPK. Handbuch zur Dokumentation in landesgesundheitsfondsfinanzierten Krankenanstalten — Anhang 1: Aufbau und Inhalt der Datenmeldungen 2025 (SP3), Kap. 2.4 Intensivdokumentation (Satzart I11 SAPS3-Daten, I12 TISS-A-Daten).
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