9 EQUIVALENTS OF NURSING MANPOWER USE SCORE (NEMS)

Objectives:To develop a simplified Therapeutic Intervention Scoring Sy stem (TISS) based on the TISS-28 items and to validate the new score i n an independent dat abase. Design: Retrospective statistical analysis of a database and a prospective multicentre study. Setting: Developme nt in the data base of the Foundation for Research on Intensive Care i n Europe with external validation in 64 intensive care units (ICUs) of 11 European countries. Measurements and results: Development of NEMS on a random sample of TISS-28 items, cross validation on another rando m sample of TISS-28, and external validation of NEMS in comparison wit h TISS-28 scored by two independent raters on the day of the visit to the ICUs participating in an international study. Multivariable regres sion techniques, Pearson's correlation, and paired sample t-tests were used (significance at p < 0.05 level). Intraclass correlation, rate o f agreement, and kappa statistics were used for interrater reliability tests. The TISS-28 items were reduced to NEMS (9 items) in a random s ample of 2000 records; the means of the two scores were no different: TISS-28 26.23 +/- 10.38, NEMS 26.19 +/- 9.12, NS. Cross-validation in a random sample of 996 records; mean TISS-28 26.13 +/- 10.38, NEMS 26. 17 +/- 9.38, NS; R-2 = 0.76. External validation on 369 pairs of TISS- 28 and NEMS has shown that the means of the two scores were no differe nt: TISS-28 27.56 +/- 11.03, NEMS 27.02 +/- 8.98, NS; R-2 = 0.59. Reli ability tests have shown an ''almost perfect'' interrater correlation. Similar to studies correlating TISS with Simplified Acute Physiology Score (SAPS)-I and/or Acute Physiology and Chronic Health Evaluation I I scores, the value of NEMS scored on the first day accounts for 30.4 % of the variation of SAPS-II score. Conclusions: NEMS is a suitable t herapeutic index to measure nursing workload at the ICU level. The use of NEMS is indicated for: (a) multicentre ICU studies; (b) management purposes in the general (macro) evaluation and comparison of workload at the ICU level; (c) the prediction of workload and planning of nurs ing staff allocation at the individual patient level.