RI Triage is a risk stratification module for use with adult patients (18 years of age and above) for use in Emergency Departments (ED) that utilizes Rothman Index (RI) scores that are produced by the RI Server. RI Triage provides an estimated risk level to support clinicians in determining the appropriate level of care for patients to optimize hospital resources and patient outcomes.
RI Triage utilizes the same data and shares many components of RI Trend. The RI Triage module will take advantage of the existing HL7 data feeds (ADT, ORU) for patient admission, discharge, transfer and vital signs. A clinician will perform nursing assessments that can be entered directly into RI Triage for the RI Server to calculate the RI score and associated patient estimated risk level. In addition to entering the
nursing assessment the clinician can enter if there is any indication for a specific disease, such as COVID, that will be evaluated by the rules engine to determine the estimated risk level.
Note that RI scores will not be stored if the RI Server is not running. In addition, the same processing rules apply for data availability to calculate an RI score and therefore estimated risk level as described in the Inputs to RI Score section.
RI Triage provides users with two basic views of estimated risk level:
Array View: A dashboard-style view where multiple risk cards are displayed simultaneously, disease classification (if appropriate) organized by estimated risk level (risk lanes).
Patient Specific View: An individual patient's risk graph from which users can see an individual patient's RI score, decrease classification and estimated risk level, as well as patient visit and demographic information.
Risk Level
An estimated risk level provided by RI Triage is a support tool for clinicians to reference when making care decisions for their patient. The clinicians can refer to the patient specific view that provides a card with the estimated risk level and the date/time the estimated risk was determined. The view also includes a bar graph designed to show where the patient’s RI Score lies relative to the configured risk thresholds. The proximity to the particular estimated risk level is represented by how much of the bar is colored in the three different sections.
RI Triage offers a three-tiered approached to estimated risk level which are:
- High -Red
- Medium - Yellow
- Low - Green
- Risk Unavailable - Gray
The Risk Unavailable category is used for patients that have not had all the required data entered or the
data has expired to calculate an estimated risk level. The estimated risk lanes are categorized patient risk cards for the current risk level. For example, patients meeting the rule of the “High” risk level will be categorized with a “High Risk” designation.
A patient’s estimated risk level is determined following the calculation of the RI score from the RI Server. The estimated risk level will expire after 24 hours (configurable duration) and require the user to re-enter a nursing assessment to obtain a new estimated risk level, as long as their vitals are current. Estimated risk levels are based upon “rules” (criteria) related to the RI score and COVID classification. Two rules are configured during implementation that will be utilized by the rules engine to determine the estimated risk level. There is one rule each for patients with COVID and one for patients that are non-COVID. The rule will provide the RI score ranges that are to be evaluated to determine the estimated risk level. For example, for a COVID patient, the RI score will be evaluated according to the rules for suspected COVID risk thresholds. The lower the RI score the higher the patient’s estimated risk level. The rules for the estimated risk level are configured during the RI Triage implementation process.