An early warning system

Nurses often talk about having a sixth sense. A gut feeling says something is wrong with a patient, but putting that intuition into words and validating it can be hard. Perhaps a patient isn’t eating or drinking as much as the day before or the texture of their skin changed slightly. Maybe yesterday their mind was clear and today they are confused. These subtle changes could be early signs of a person’s health deteriorating, and they are picked up by a digital tool called the Rothman Index.

The Rothman Index is an early warning system that helps a medical team predict a potential emergency and intervene before it happens. More than 700 data points from a patient’s medical record are plugged into an algorithm in real time – vital signs, lab results, cardiac rhythms and nursing assessments – to generate a visual dashboard of how the patient is doing and trigger a warning if there is a decline.

“All of our inpatients have the benefit of this early warning system,” said Andrew Resnick, MD, chief medical officer of the Froedtert & the Medical College of Wisconsin health network.

“Our leadership in health care quality is nationally recognized, and our outcomes are among the best in the nation, but there is always room for improvement. The Rothman Index is the only tool that objectively captures the essence of how a nurse is feeling about a patient and supports our clinicians in making the best care decisions.”

monitoring-dashboard-perawatch

Virtual monitoring leads to proactive care

Rothman Index data exists for all inpatients at the following Froedtert & MCW hospitals: Froedtert Hospital, Community Memorial Hospital and St. Joseph’s Hospital. It is monitored 24/7 by a virtual care team, located in the office of Inception Health, the health network’s innovation accelerator. The team is composed of critical care physicians, nurses and advanced practice providers.

“They are experienced in their practice,”said Erin Green, RN, executive director of clinical operations at Inception Health. “The virtual care team knows what to look for, where to find it and the important questions to ask in order to translate the data to get a clear clinical picture of the patient, which will support proactive intervention by the bedside team.”

The virtual care team acts as a safety net and an additional layer of support. When a change in a patient’s condition triggers a warning, the virtual care team gets the alert. A virtual care team nurse conducts a detailed review of the patient’s chart and reaches out to the patient’s bedside nurse for further evaluation and discussion. They partner to decide on next steps and take action. The idea is that two minds are better than one. “We’re being proactive,” said Rose Gaskell, RN, director of nursing special projects for the health network.

“We’re catching things earlier, providing better care to the patient by pre-empting critical situations and keeping them out of the intensive care unit.”

It started with a patient named Florence Rothman

The Rothman Index gets its name from Florence Rothman, an 87-year-old woman who was hospitalized in Florida for a heart valve replacement and died. Initially, Florence appeared to recover well from the surgery, but her health steadily declined, and a few days later, she was in critical condition. Her doctors were competent, but subtle changes in her health had gone unnoticed and Florence died of a common, treatable complication. In an effort to prevent this from happening again, Florence’s sons, Michael and Steve Rothman, developed the Rothman Index.

Michael Rothman holds a PhD in quantum chemistry and had worked as a computer scientist at IBM. He also worked at IBM’s T. J. Watson Research Labs, in the AI (artificial intelligence) department. Steven Rothman is an electrical engineer. Neither brother had a background in medicine or health, but they got the support of Sarasota Memorial Hospital, the hospital where their mother was a patient, to analyze electronic medical record (EMR) data.

According to the Florence A. Rothman Institute, “their vision was to create algorithms that would utilize existing EMR data to track patient health status over time, and to present this information as simple and meaningful metrics, available to the clinician in near real time.”

In 2010, the brothers founded Rothman Healthcare and developed software for health care providers to use the Rothman Index. In 2012, Rothman Healthcare became PeraHealth Inc.

Improved clinical outcomes

The Froedtert & MCW health network was the first in Wisconsin to start using the Rothman Index in early 2018, and one of about 80 in the country. The clinical outcomes of the Rothman Index have been studied, and two major clinical trials, at Houston Methodist Hospital and Yale-New Haven Hospital , have shown a 30 percent reduction in mortality over a one-year period. Hospitals are also using the Rothman Index to make decisions regarding patient placement, transitions of care and discharge readiness.

“The Rothman Index is a common language for our clinicians,” said Michael Stadler, MD, a head and neck surgical oncologist with the Froedtert & MCW Cancer Network. “It provides another data point we can use to make important decisions. For our patients, it means another set of eyes on your care team.”

To learn more, visit froedtert.com/quality


  1. https://qualitysafety.bmj.com/content/25/12/1014  
  2. https://qualitysafety.bmj.com/content/24/11/734 
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