In the white paper, “Intelligent Early Warning: Leveraging the Power of EHR Data to Improve Patient Safety, a Comparison of the Rothman Index with MEWS and NEWS,” PeraHealth compares the Rothman Index to other early warning systems.
The Modified Early Warning Score (MEWS) is based on a patient’s respiration rate, heart rate, temperature, systolic blood pressure, and level of consciousness. Pediatric variants include the the Pediatric Early Warning Score (PEWS). In addition, the United Kingdom proposed the National Early Warning Score (NEWS), a variant of MEWS to standardize early warning scoring across hospitals.
The table below compares the inputs and operations of these early warning systems:
COMPARISON: PEWS, MEWS, NEWS, AND ROTHMAN INDEX
| Types of Data Included | PEWS (inputs vary) |
MEWS
(5 indicators) |
NEWS
(7 indicators) |
Rothman Index Score
(26 indicators) |
||
| Vital Signs | · Respiratory rate
· Systolic BP · Diastolic BP |
· Respiratory rate
· Heart rate · Temperature · Systolic blood pressure |
· Respiratory rate
· Heart rate · Temperature · Systolic blood pressure · Oxygen Saturation (& if suppl. O2) |
· Respiratory rate
· Heart rate · Temperature · Systolic blood pressure · Diastolic blood pressure · Oxygen Saturation |
||
| Lab Results | N/A | N/A | N/A | · Sodium
· Potassium · Creatinine · Chloride · Hemoglobin · Blood urea nitrogen · White blood cell count |
||
| Functional Status based on Nursing Assessments | · Psychosocial
· Respiratory · Cardiovascular |
Consciousness level (i.e., AVPU) | Consciousness level (i.e., AVPU) | · Braden scale (pressure ulcerrisk)
· Cardiac · Food/nutrition · Peripheral-vascular · Psychosocial · Skin · Respiratory · Safety/fall risk · Gastrointestinal · Genitourinary · Heart rhythm · Musculoskeletal · Neurological (including GCS / consciousnesslevel) |
||
| Sophistication of Risk Analysis | Groups clinical values into 3 risk “buckets.” | Groups clinical values into 3 risk “buckets”
above and below a pre-defined normal range. |
Groups clinical values into 3 risk “buckets” above and below a
pre-defined normal range. |
Uses a continuous age-adjusted function to assign a precise risk value according to the exact value of each clinical input | ||
| Visualization | Minimal visualization. Single number, sometimes color coded for acuity | Minimal visualization. Single number, sometimes color coded for acuity | Minimal visualization. Single number, sometimes color coded for acuity | Graphical visualization of patient condition, in the moment and trended over time | ||
| Units Covered | Med/Surg only | Med/Surg only | Med/Surg only | All units including ICU | ||
| Input/ Calculation Approach | Nurse must enter data | Nurse must enter data | Nurse must enter data | No additional data entry; automatically pulled
from EMR |
||
| Frequency | 3-5 points per day | 3-5 points per day | 3-5 points per day | 10-20+ points per day | ||
| Warnings | Warnings based on thresholds passed due to vitals | Warnings based on thresholds passed due to vitals | Warnings based on thresholds passed due to vitals | Warnings based on changes in physiologic state, ability to trigger based on score and trend | ||
The white paper concludes:
- As a next-generation, EMR-integrated platform that facilitates proactive intervention and uses nursing assessments, the Rothman Index is a significant advancement from standard vital-sign based systems.
- Generation of Rothman Index scores and warnings is effortless, and the Rothman Index calculates scores continously, rather than sporadically like MEWS, NEWS, or PEWS.
- The difference in the false positive rate is significant, as the Rothman Index provides a better-targeted early warning platform.
To learn more:
Download the full white paper.
Register for our live webinar, “The Rothman Index: An Earlier Warning System”:
July 17, 2019
1-1:30 p.m. ET
Speakers:
- Michael Stadler, MD, FACS, Assoc. Professor; Assoc. Chief Medical Officer, Medical College Physicians/Froedtert Hospital; Chief, Div. of Head & Neck Surgical Oncology and Reconstruction, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
- Jonathan Fullerton, Managing Director, Strategic Initiatives, PeraHealth