Shannon Medical Center | Health Beat | Fall 2019

6 HEALTH BEAT Patient care D elivering patient care is an intricate, complex job requiring vast knowledge, keen judgment and difficult problem solving based upon observation, analysis, data and experience. Our patient care teams at Shannon strive each day to deliver our mission of providing exceptional patient care in the most compassionate way. One important tool, the Rothman Index, provides additional support in this important job. Shannon Medical Center first implemented PeraHealth’s Rothman Index software tool in 2012. Over the last seven years, Shannon has seen it benefit patient care in many areas, including reduced length of stay, reduced readmissions, more informed decisions for patient transfer and discharge, increased safety, and overall improved care. The Rothman Index was created by brothers Michael and Steven Rothman after the death of their mother, Florence. She died from an undiagnosed and unnoticed complication days after undergoing a sur- gical procedure. Her sons believed that if her physi- cians had had more data on the subtle changes in her condition, they would have been able to intervene to save her life.They created a digital solution that inter- faces with a patient’s medical record and provider ex- pertise, and it is now used in hospitals across the U.S. The Rothman Index is an algorithm that derives one simple score from the vast amount of data in the electronic medical record to create a picture of any patient’s condition over time—any age, any disease, any unit. It can detect patient deterioration hours or days earlier than existing scores and systems. “The Rothman does not replace the nursing assessment,” says Becky Fuentes, MSN, RN, NE-BC, Associate Chief Nursing Officer at Shan- non. “Instead it relies on the clinical assessment and documentation of our nurses. It then takes the vital signs and lab data with other factors to help create an overall assessment of the patient.” Improving care Shannon’s Skilled Nursing Unit utilizes the Rothman Index during every shift change and at bedside care. The unit achieved the lowest hospital readmission rate in the community, nearly 10% lower than the national skilled nursing facility average. In addition, the unit received the bronze McKnight’s Excellence in Technology Award for its admissions process. It began using the Rothman Index to establish whether an acute care patient in the hospital is ready for skilled care. After the patient transitions to skilled care, the Rothman In- dex also helps establish readiness for discharge. “We have also started utilizing the Rothman Index score in discussions with family mem- bers about next steps in care for their loved one,” Becky says. “It has been very beneficial in discussions about when patients should transi- tion to palliative care. While it may appear that a patient is in stable condition, they may actually be experiencing a decline in condition, and the Roth- man score over time is a visible way that family members can better understand the changes in their loved one.” Shannon recently implemented an upgrade to the software during the summer to provide more visibility into specific patient populations as well as across multiple units to further guide patient care priorities. “The additional intelligence we gain through the Rothman Index offers one more level as we provide the best possible care to our patients at the right time,” Becky says. How it works The Rothman tool compiles 26 elements of a pa- tient, including a combination of lab data, nursing assessments and vital signs documented in Epic, and creates a score for the patient. This score is trended based on the patient and assessment data. When the score declines, it sends an alert to the care team. “A patient may look fine, but there may be subtle internal changes in their condition that are not no- ticeable as physical symptoms until their condition worsens considerably,” says Becky. “The Rothman alerts us to these changes so that we can go into the patient’s record, look at the score and other data, and make changes to their care plan. The ability to see these changes more quickly makes a considerable impact on the patient’s care.” The Rothman Index assists in indicating subtle changes in cardiac, respiratory, GI, neurologi- cal, psychosocial or musculoskeletal function— changes that may quietly indicate decline but could go externally unnoticed until the patient has reached a serious decline. “We’ve seen such a positive impact for our patients and our care delivery at Shannon, and we look forward to even more improvement with future advances.” —Becky Fuentes, MSN, RN, NE-BC, Associate Chief Nursing Officer The Ro thman Index he l ps prov i de r s de l i ve r exc ep t i ona l c a re A complete picture of health