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Applying the Rothman Index to Reduce Mortality: Oconee Memorial’s Bold Push

January 18, 2015
by Mark Hagland
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One South Carolina hospital is leveraging a commercialized solution that brings the value of the Rothman Index directly to nurse managers

One South Carolina hospital is leveraging a commercialized solution that brings the value of the Rothman Index directly to nurse managers, in order to reduce patient mortality, improve clinical outcomes, and enhance efficiency

At Oconee Memorial Hospital in Seneca, South Carolina, clinician and clinical informatics leaders are making major strides in monitoring patients for sudden changes in medical condition. Oconee Memorial is a 169-bed community hospital in a small town located halfway between Charlotte and Atlanta. There, Sarah James, R.N., the hospital’s nursing information systems coordinator, has been helping to lead an initiative that is already paying dividends.

James and her colleagues have been partnering with the Charlotte-based PeraHealth, a vendor whose core solution has helped to operationalize the use of the Rothman Index in order to support the optimal monitoring of patient conditions. The Rothman Index, as explained in a Wikipedia entry on the subject, “captures data found in a hospital's electronic health record and displays the progression of a patient's health over time. The Rothman Index generates a regularly updated health score synthesizing routine vital signs, nursing assessments, and lab results, for display in a user-friendly graphical format, summarizing thousands of pages of patient data at a glance. The Rothman Index simplifies the tracking of patient progress and detects subtle declines in health. Rapid response teams, physicians and nurses have the ability to see multiple patient graphs simultaneously. This allows for earlier interventions and a summarized understanding of a whole unit, providing patients with the extraordinary care they need effectively and efficiently.”

As the Wikipedia entry also notes, “The Rothman Index is named in honor of Florence Rothman. In 2003, Florence underwent an operation to replace a heart valve at Sarasota Memorial Hospital. Although her health initially improved after the operation, it gradually worsened until she died 10 days after the operation. Her sons Michael and Steven Rothman determined that it was the overall system of care that failed her by not detecting her gradual health deterioration. Their solution was to develop a simple measure of a patient’s overall condition that can be plotted versus time to show a doctor or a nurse whether a patient is recovering or deteriorating. They worked with Sarasota Memorial Hospital by analyzing thousands of patient records in the Electronic Health Record to develop the Rothman Index.” David and Michael Rothman had worked with David Classen, M.D. the CMIO at the Washington, D.C.-based Pascal Metrics, to develop the core of the Index, according to a 2013 article by Craig Clapper of Healthcare Performance Improvement.

Sarah James spoke recently with HCI Editor-in-Chief Mark Hagland about the Oconee Memorial initiative in this area. Below are excerpts from that interview.

What is the background to your current initiative? And what have been your broad operational goals in pursuing it?

We implemented our current EHR [electronic health record] in April 2013; it’s McKesson’s Paragon. So with that, we were presented with this huge array of information. It’s the same challenge hospitals are facing everywhere; we have all this information, and the question is, what do you do with it? And the solution for us was ParaTrend. It came to us through our CEO, who had seen a demo of it and who had offered it to our CNO as a solution to help nursing interpret this massive amount of information. That’s why we initially started looking at ParaTrend. And we realized it could also reduce the number of rapid responses and Code Blues, and could help us intervene earlier in situations where patients were declining. That perked up our CNO’s ears, and she was immediately on board, so we began a project using that solution in February of this year [2013]; by April or May, we were digging in pretty deep.

The nursing assessment and lab reports and vital signs are run through the Rothman Index algorithm, and it creates an individual patient score. It runs from 0 to 100, with 100 being a totally healthy person. As the number goes down, that correlates to the risk for mortality. So each patient has a graph that’s updated, based on however frequently your system is running. Our system updates the graph every five minutes. So currently, the way we’re using it is that our nursing supervisors, when doing handoffs shift to shift, are pulling up the entire hospital on a computer monitor—and the solution allows for patients with significant drops, based on parameters we choose—it puts them into “swim lanes” that draw your attention to them. It could be based on a certain percentage drop in the Rothman Index, or based on a certain number of points. There are typically three levels of risk: very high risk, high risk, and moderate risk.

So a patient who dropped from, say, 45 to 25, would probably flash in the dashboard as an alert?