Time oriented score system (TOSS): a method for direct and quantitative assessment of nursing workload for ICU patients. Italian Multicenter Group of ICU research (GIRTI).

A method for direct quantitation of nurses' workload required by ICU patients is described. Each nursing activity has been timed in 14 different ICUs participating in the multicentre study, and the results averaged. Nursing acts were grouped in different homology lists, complied according to operative similarities. Some lists include general nursing acts, which are common to all patients admitted to ICU, others include acts peculiar to different organ system abnormalities or acts ancillary to the general group, finally one list includes emergency or occasional acts which are not encountered in every patient. The TOSS is a simple and rapid method for ICU nurses' workload assessment, can be computed both at admission and during the stay in ICU, and can provide factual information on the nurse/patient ratio necessary in a specific environment. TOSS validation was conducted with a yearly prospective study collecting 2710 patients. TOSS values varied according to diagnosis, severity of illness (SAPS) and intensity of processes (TISS), and TOSS specificity was demonstrated by the possibility of selecting a wide combination of nurse/patient ratios from 1:4 to 1:1 not possible with TISS.