PeraHealth Insights

Upstream Risk Management Benefits of the Rothman Index

Risk managers play a guiding, cross-functional role at the center of safety, liability, and cost. As health systems face intense regulatory pressure, relentless community scrutiny, and increased data transparency requirements, risk management has never been more critical.

Bearing this weight, risk managers struggle to get upstream of risk, looking for opportunities to predict and mitigate events, rather than operating purely at a reactive level. On July 25, PeraHealth’s Strategic Initiatives team hosted the webinar, “Leveraging the Rothman Index for Risk Management”. We shared initial results of a six-month research initiative that examined the possibility of integrating the Rothman Index (RI) into a comprehensive risk management strategy. With proven results including 30 percent reductions in all-cause mortality, more effective and earlier identification of sepsis, significant reductions in length of stay (LOS) and cost per case, our research suggests the RI can be a powerful lifeboat for the risk management agenda.

Top webinar takeaways:

A key component to helping risk managers get upstream of risk is to provide information that allows them to quickly orient to patient status across the house. Advanced clinical surveillance solutions help risk managers do exactly that: integrate real-time patient data from multiple sources and apply advanced algorithms to reveal the current state and overall trend of patient’s condition. The peer reviewed and validated Rothman Index can support risk manager efforts to understand, in real time, pockets of risk and where to prioritize their risk management efforts.

The RI effectively reflects patient condition across the continuum, regardless of disease, diagnosis, and acuity. The RI is unique in its “data fusion” model by successfully integrating nursing assessments (qualitative data) with labs and vitals (quantitative data). Hospitals collaborate with the PeraHealth team to customize data-based RI rules and alert thresholds.

The integration of nursing assessment data is a unique and patent-protected component of the RI. Nursing assessments have been clinically proven to contain predictive power regarding patient condition. In fact, nursing assessments pick up subtle clues long before problems manifest as vital sign derangement.

Case study insights from an academic medical center show that RI warnings flag patients at risk for deterioration hours – sometimes days – prior to adverse events.

  • The RI can help trigger palliative care screenings and consults, as demonstrated by Yale New Haven Health.
  • PeraAnalytics™ is a real-time and retrospective reporting tool that can help risk managers report and review events through root cause analysis and mortality reviews.
  • On the liability front, executives running captive insurance companies have a challenging role. On one hand, they are insurance providers owning execution of a sound claims management approach. On the other hand, they are health system employees; and in that role, they need to understand the entire enterprise and clinical workflow.
  • For risk managers that manage or participate in a captive, there is clear evidence that the RI can help reduce claims costs. Captives have a tremendous advantage over a private insurance carrier that has no relationship with the health system, and the most strategic captive managers are participating in clinical investment decisions with the eye toward supporting the goal of reducing claims (while maximizing patient outcomes and safety).
  • Getting upstream of risk and patient harm requires proactive systems and processes. The marriage of rounding and clinical surveillance is “proactive rounding.”

We invite you to join our next webinar, “Proactive Rounding Based on Clinical Surveillance: A Team Approach for Rapid Response and Improved Patient Outcomes,” when Carilion Roanoke Memorial Hospital and Penn State Health Milton S. Hershey Medical Center will share innovative approaches for using the RI to integrate proactive rounding with clinical workflows and reduce code blue events.