Background Early detection of subtle changes in a patient's condition is critical to patient safety, but is difficult to achieve, even with electronic medical records.
Objectives To identify at-risk patients and reduce in-hospital mortality through the implementation of surveillance protocols based upon a patient acuity score.
Methods The Rothman Index (RI) is a validated patient acuity score, integrated into the EHR, updated in real-time, computed using: vital signs, laboratory values, and nursing assessments. In a nurse-driven initiative at Houston Methodist Hospital, a surveillance system based on RI was implemented on 11 clinical units. On each unit, RI-time-graphs, one for each patient, color-coded by severity, organized so that patients with poor or deteriorating scores were highlighted, were displayed. Graphs were reviewed by nurses at shift-change, during safety huddles, at least 5 times per day. Nurse practitioners rounded on those patients whose RI graphs were highlighted as high risk. Protocols were established for bedside nurses, and charge nurses, specifying actions (e.g. increased monitoring, notification of physicians) required upon triggering of a high risk alert level.
Results Risk adjusted mortality (using the UHC mortality model) fell 32% in the 9-months following the intervention as compared to prior 9-months (historical control). Also there was a coincident control group, the remainder of the hospital, where risk-adjusted mortality was unchanged during the 18-months.
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