Rothman Index Trend Overview
Rothman Index Trend is an interactive graphical representation of RI scores and related measures. The information displayed in RI Trend is based on data automatically received and/or processed by RI Server. No additional data entry or documentation is required and RI scores are calculated and updated as data comes in. If in use, some features are available that rely on data entry into the application . RI Trend is intended to support clinicians in surveilling large volumes or patients throughout the hospital setting (e.g. in the emergency department, on the wards, in intensive care units) and across multiple hospitals in a centralized and/or remote setting as an adjunct to clinical decision making.
Note: RI scores will not be generated if the RI calculator is not running and warning states will not be generated if the RI calculator and/or rules and warning engines are not warning.
RI Trend provides users with two basic views of RI scores:
- Array View: A dashboard-style view where multiple graphs are displayed simultaneously, organized by warning level (warning lanes) as the default. other filters are available for the user to select based on their desired organizational display. This view also provides a 'Warning Panel' that allows end-users to be able to track and monitor warning state change notifications that occur during their RI Trend session.
- Patient Specific View: An individual patient's graph from which users can see an individual patient's RI score over different time spans, and access clinical inputs to each RI score, as well as patient visit and demographic information, and warning details.
Indications for use
RI Trend is indicated for use by healthcare providers whenever there is need for displaying and/or trending Rothman Index scores and displaying associated configurable warning states as an adjunct to clinical decision support.
RI Trend is intended for the care of patients' throughout the hospital setting (e.g. in the emergency department, on the wards, and intensive care units).
The Rothman Index score is validated for use with neonatal, pediatric, and adult patients. It is adjunct- to and is not intended to replace vital signs monitoring and is not intended for use in the Neonatal Intensive Care Unit.
Expectations for Use
Expectations for the use of RI Trend, including workflow integration and protocols for use, are determined by each customer organization in accordance with their respective clinical aims and policies, as well as clinical teams in place with the organization such as dedicated rapid response team.
Reliance on Documentation
RI Trend is based on data received from the EHR and ancillary (e.g.., lab registration and ADT) systems. Inaccurate or delayed clinical documentation may lead to inaccurate or delayed RI scores. Timely documentation is required to obtain the most up-to-date RI Server information related to a patient's condition.
CAUTION: RI Scores displayed in a RI Trend graph may not reflect the current condition of the patient.
The lag time that may exist between the time when clinical measurements are obtained and the time when they are entered into the EHR is a fundamental challenge in assessing patients via EHR data.
CAUTION: As new data is received by the RI Server system, RI scores at previous times may not be updated on the RI Trend graph.
A clinician who wishes to see the RI score of a patient in the current moment must ensure that current clinical data is collected and entered into the EHR to generate an RI score reflective of the patients' condition at the same moment. Delays in entering data into the EHR will result in RI Trend graphs that are not current; and users must be aware of the risk that RI scores displayed in a RI Trend graph may not reflect the most up-to-date condition of the patient.
CAUTION: RI scores can only be computed when the requisite data is available. For some patients, particularly obstetric and psychiatric patients, the minimum data elements (including nursing assessments) needed for an RI score may not be routinely collected, and therefore RI scores for these patients may not be available. Provided that the minimum required data elements are recorded and entered into the EHR, RI scores will be calculated for these patients.
Customers must inform Spacelabs about changes to clinical data fields or system documentation that pertain to any of the fields used as inputs to the Rothman Index.
Training and Education
Before using RI Trend, users should be sure they have received organizational training and instruction regarding the appropriate and expected use of the application. Customer organization are responsible for ensuring appropriate use of the product.
Organizations will develop their own protocols for use and determine how end-users should integrate RI Trend into their workflow. When in doubt, users should seek guidance from appropriate members of their organization's staff.
Most customer organizations contract to utilize Spacelabs clinical implementation services. Spacelabs can provide guidance on implementation strategies, as well as deployment support that can include on-site or remote training by Spacelabs staff together with supporting information and training material.