PeraHealth Insights

Doc, how is he doing?

Conversations about care decisions can be difficult for patients, their families, and clinicians. For the first time, there is a single objective score that answers the question – “Doc, how is he doing?”

In the case study article, “Shared decision-making at end-of-life is aided by graphical trending of illness severity,” from BMJ Case Reports (2014), authors David B. Bittleman, Alan B. Solinger, and G. Duncan Finlay describe how clinicians shared a patient’s Rothman Index graph with his family at Sarasota Memorial Hospital to help prompt “frank discussions of prognosis and consideration of comfort measures…”

In that case, the patient was an 85-year-old man who required a craniotomy and a stay in an intensive inpatient rehabilitation unit. The Rothman Index provided an “unambiguous visualization of the trend of patient acuity, which depicted the patient’s persistent decline in health and made clear to the family the situation of the patient.” The family thoughtfully considered the options and his wishes before they enrolled him in hospice care, where he died peacefully.

Learning points from the study include:

  • “Families of sick patients want caregivers to talk to them, frankly discuss the facts pertaining to the acuity status of the patient, and formulate prognoses.
  • The Rothman Index can help the physician initiate discussions about end-of-life care and hospice in patients who are dying because it simply presents the evidence, without judgement or emotion.
  • Physicians can use the Rothman Index to communicate better about many issues involving patient’s condition and progress and help make plans for patient disposition.”

Since the BMJ article was published, the Rothman Index has continued to help hospitals across the country. Yale New Haven Health has used the Rothman Index to trigger palliative care consults and has achieved a 12.4-day reduction in length of stay (LOS) for palliative care and 54% cost reduction for palliative care (J Hospice & Palliative Nursing, 2017). Read the case study. 

The Rothman Index is the only proven algorithm that derives one simple score from the vast amount of data in the electronic medical record to create a picture of any patient’s condition over time – any age, any disease, any unit. It can detect patient deterioration hours or days earlier than existing scores and systems.

To learn more, register for our June 5th webinar: “The Rothman Index for Palliative Care – Have the Conversation.”