How one hospital saved 77 lives with EHR data and the Rothman Index

Over a nine-month period between 2014 and 2015, the Houston Methodist Hospital in Houston, Texas, successfully saved the lives of 77 individuals thanks to an innovative early warning system.

An early warning system
According to Health Data Management, the early warning tool implemented at the 1,119-bed Texas hospital operates by continuously scanning electronic health records for patient conditions that may be quickly deteriorating. For nurses who first utilized the early detection system, they witnessed a 32 percent decline in the risk-adjusted mortality date. Included in that drop was an 8 percent decline in sepsis deaths.

"This tool is saving lives that at one point we would have considered unavoidable deaths," said Dr. Katherine Walsh, vice president of operations and chief nursing officer at Houston Methodist St. John Hospital. "It's an easy-to-use tool that helps us intervene sooner to further improve outcomes." 

The Rothman Index
According to Healthcare Informatics, the early warning system utilizes the Rothman Index, which bases the condition of a patient on a scale from 0 to 100, with zero being the worst condition or health. Pulling data from the EHR and other information technology, the disease-agnostic measurement system is used to analyze the readmission risk and mortality rate of a patient. Lab values, vital signs and assessments from nurses and physicians are taken into account and calculated by an algorithm to produce the Rothman Index number.

If or when a patient's status starts to deteriorate, nurses will follow protocol by taking vitals, administering assistance or calling on the rapid response team. At Houston Methodist, nurses using the system follow guidelines from the nursing leader.

How it all began
The Rothman Index was created by Michael Rothman, PhD, following a personal experience involving the death of his mother after a non-invasive, routine surgery, according to Mediaplanet. Looking back at what went wrong during a 2003 heart-valve procedure, Rothman and his brother Steve asserted that the death was completely avoidable. The complication that ensued after she was discharged from the hospital went unnoticed by hospital staff. At the time, there were no tools to identify those small changes in her condition – changes that could have saved her life if identified by nurses.

"Although the electronic health record had all the data in it, it was impossible to see a trend," Rothman said, according to Health Data Management. "And that's what the clinicians missed in my mother. They could not see the downward trend in her condition."

Tracking the details
Setting out to fix this glitch, the brothers developed the early warning system that uses 50 unique healthcare measures to track the conditions of patients, according to Mediaplanet. Rothman explained that the system aimed to change the way a patient's condition was monitored. Often times, physicians and nurses miss the small, gradual changes in an individual because they're usually buried in the EHR. However, the Rothman Index is able to monitor each and every minor change in the patient and his condition. The day after day, hour to hour and  visit to visit modified system can detect life-threatening and then, life-saving, changes.

Health Data Management reported another unique piece of the system is that it effectively captures and records the frequent data input from nurses when they conduct their routine checks of a patient. Standard practices require nurses to check that each physiological system of a patient is working properly. Once they have a hold on the individual's normal functional status, they're better able to pick up when something is wrong. 

Saving lives
Health Data Management reported that the system was originally piloted in 11 of the Houston Methodist nursing stations. The notable success has led to all nursing units using the system and several other hospitals in the Houston Methodist system are set to start implementing it soon as well.

Best of all, the system does not require any additional data entry because everything that the early warning tool uses has already been documented in the EHR. There were three effective strategies that the hospital used for successfully implementing the new system, according to Walsh. The first tactic was to have nursing leaders oversee the new system. Then, the tool and index were made extremely visible by large TV monitors at all times. The color-coded system made it easy for those passing by to see if patients were stable (blue) or had begun to deteriorate (yellow) or were at high risk (red). 

The third strategy that led to the smooth implementation of the new system was open discussion. According to Walsh, Houston Methodist took the time to really educate the nursing staff on the importance, and power of, the tool. They were encouraged to share stories of how the early warning system had proved life-saving and, with 77 lives saved thus far, it has certainly worked.