Frequently Asked Questions

How do the raw variables analyzed by the Rothman Index produce the score?
For each variable we compute risk as a function of that variable. For example, a heart rate of 70 would add essentially zero risk, but a higher or lower heart rate would add increasing degrees risk. Risk is summed across the variables and scaled appropriately to compute the Rothman Index, which represents the total risk for that patient at that time. It was empirically derived from 22,000 patient records and originally validated on data from 25,000 records; it has subsequently been validated on a further 300,000 records.
Why is pain not included?
Pain is not included because it was found to have no correlation with risk. Research shows that patients who are very ill are often heavily medicated and therefore experience no pain, whereas a patient with a less severe condition may have substantial pain.
Will we be more liable to malpractice claims because of this tool?
Liability could decrease because of this tool. All of the information used is already part of the medical record. Since the tool is designed to bring trends to clinicians’ attention, they are less likely to be guilty of errors of omission. The Rothman Index does not prescribe any actions, but rather should be considered as clinicians apply their medical expertise and judgment.
When responding to a falling Rothman Index Score, what is the critical thinking process?
It is important to understand that the value of the Rothman Index is in seeing trends in a patient’s condition not easily appreciated otherwise. In the majority of cases, caregivers are well aware of the situation and no extra attention is required. Most often a falling Rothman Index Score is associated with a case in which all are aware and responding appropriately. Sometimes, however, the clinician may not be aware of the patient’s deteriorating condition, particularly if it is changing very slowly. The Rothman Index can act as a safety net and improve communication between clinicians. Additionally, it may be just as important to recognize that a patient is not improving as expected after surgery or a change in therapy, or that a patient is progressing more quickly than expected.
Can we avoid unnecessary 30-day hospital readmissions?
The RI tool allows us earlier intervention which could save a trip to the ER. It lets us see gradual deterioration that may be missed by caregivers who see a patient everyday.
Can we extend our residents’ quality of life?
Yes, by being proactive rather than reactive, early intervention gives a better quality of life. This is our mission.
How can we improve communication within our facility and with families?
The graph summarizes a patient’s condition. It provides an objective vs. subjective view. It is a valuable tool to see what has happened to a patient and help in critical decision-making. It offers oversight capability for management to help with staffing, communication, etc. Nurses can talk to physicians remotely and make better decisions on behalf of the patient. It is a way to communicate with family members and aids in determining proper placement, e.g., when palliative care may be more appropriate.
Can a patient be tracked after discharge to catch decline?
Yes, it is applicable in home, independent living, assisted living and skilled nursing. By teaching patient or caregiver how to use the RI, they can go home and be tracked by the facility. The system is very user friendly and can be used via voice recognition detail or iPad, etc. It is reimbursable by Medicare.