Predicting the Patient: Using Analytics for Better Outcomes

The Electronic Health Record (EHR) is essential for clinical and nursing teams to make critical patient care decisions, but what if even more patient data could be accessed? Through the use of predictive analytics, a patient’s care team can predict where the patient’s condition is heading, which leads to more informed care decisions. In this conversation, Natalie Correll-Yoder, critical care clinical nurse specialist with NorthBay Health, and Nikki Rasmussen, senior clinical account manager with Spacelabs Healthcare, discuss one such predictive analytics tool, the Rothman Index, and how it made a huge impact for NorthBay Health's employees, and most importantly, its patients. This podcast is brought to you by Spacelabs Healthcare. To learn more about Spacelabs Healthcare please visit www.spacelabshealthcare.com.

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00;00;00;26 - 00;00;31;11
Tom Haederle
Having all patient data available on the ESR is essential for clinical and nursing teams to make critical patient care decisions. With this data, care is based on what providers can see and analyze themselves. But what if more could be done with the data? This is where predictive analytics comes in.

00;00;31;14 - 00;01;05;21
Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle, with AHA Communications. With comprehensive, real-time, accurate patient data from predictive analytics, the patient's care team can predict and can see where a patient's condition is heading to make more informed care decisions to achieve positive outcomes. Join us to hear a discussion of how NorthBay Health reduced unplanned patient transfers to the ICU by 30% and observed mortality by 16% by using the Rothman Index in its new predictive analytics model.

00;01;05;23 - 00;01;10;20
Tom Haederle
Today's podcast is brought to you by Spacelabs Health Care.

00;01;10;22 - 00;01;42;14
Marie Cleary-Fishma
I'm Marie Cleary Fishman, the vice president of Clinical Quality with the American Hospital Association. We know in patient safety and in the work that we do the goal of predictive analytics goes way beyond knowing the patient's current condition to providing the best assessment of where the patient's condition is actually headed in the future. The knowledge gleaned from predictive analytics offers more opportunities to mitigate risk of patient deterioration and escalation of care before it happens.

00;01;42;16 - 00;02;08;16
Marie Cleary-Fishma
With the power of technology and data, the care team can bolster their clinical decision making and clinical actions to actually improve outcomes and patient safety. So with me today are Natalie Correll-Yoder, a critical care clinical nurse specialist with North Bay Health, and Nikki Rasmussen, senior clinical account manager with Spacelabs. Thank you both for joining me today. We really appreciate the chance to have this conversation.

00;02;08;18 - 00;02;22;19
Marie Cleary-Fishma
Natalie, let me start with you. So predictive analytics can really be a game changer for clinicians when they're caring for patients and monitoring their conditions. How is North Bay incorporating predictive analytics into patient care?

00;02;22;21 - 00;02;50;06
Natalie Correll-Yoder
So we utilize a artificial intelligence type software that tracks the patient through documentation into the medical record and then feeds that information back to our critical care ICU nurses that are rounding on those patients to identify any changes in status that may happen so they can get to them sooner and then intervene timely to either elevate care or prevent complication.

00;02;50;09 - 00;03;14;24
Marie Cleary-Fishma
That's great. Well, we hear so much about artificial intelligence in AI, in the media and all kinds of things that people are talking about. But when you're really looking at transitioning to a predictive analytics model in the field, it's got to be a significant undertaking. So what steps did North Bay take to ensure awareness adoption and that sustained utilization of the technology while battling through COVID?

00;03;14;24 - 00;03;24;28
Marie Cleary-Fishma
That was an unprecedented time for all of us. And on top of it, you were working on all of this new technology and really looking at this to help improve care.

00;03;25;01 - 00;03;52;05
Natalie Correll-Yoder
So that is all true. And COVID challenged all of us. We had identified the Rothman Index as the tool we wanted to use prior to any kind of significant COVID breakout. And so we made a plan to roll it out throughout our health system. We are a small two hospital health system. And then as COVID came on the forefront, we decided to stage our rollout.

00;03;52;05 - 00;04;25;13
Natalie Correll-Yoder
So we focused on our intensive care nurses who were rounding in the acute care area first. They are the subject matter experts around this work, and they have the more complex, higher functioning competencies and assessment skills. And so we trained them and we did it through webinar, which is always ideal, but it was at the beginning of that before any of our technical platform technologies became a thing and we taught them how to use the Rothman Index and then set it up for them so they could then start tracking patients.

00;04;25;18 - 00;04;52;10
Natalie Correll-Yoder
And then as the warnings would come across from the Rothman, they would go out and see patients. And then that was right before the holidays of 2020, right? And then we then staged it department by department, nursing unit by nursing unit after that. And the rounders then became the true experts in the technology, identifying the patients, working with the physicians, and then the nursing staff, and then they continue training.

00;04;52;12 - 00;05;23;19
Natalie Correll-Yoder
And then for the nursing staff, we did elbow-to-elbow education because we couldn't get them in a room. We weren't allowed to have them in a room together, right? So and webinar wasn't necessarily a reasonable thing to do. So we did elbow-to-elbow education with the nursing staff, and the education team supported me in this transition and we went out to all the units and educated all the staff, spent lots of man hours, but over probably a six month period of time and then got all of our staff trained on the Rothman Index and how to utilize it.

00;05;23;22 - 00;05;46;05
Marie Cleary-Fishma
So Natalie, just talk to us a little bit about transitioning a predictive analytics model and the significance of that undertaking. Nikki, if you could give us the perspective from Spacelabs about the support and what your role is when you're implementing, and then a little bit about what your ongoing role is in supporting this kind of technology going forward.

00;05;46;08 - 00;06;08;06
Nikki Rasmussen
Thank you. That's a great question. You know, during the time of implementation, it's a very close knit process. And we did all of that remote with North Bay during that time. It was in the height of the pandemic. So we weren't at capable of getting out there to travel and do the one on one implementation the way that we would have done pre-pandemic.

00;06;08;06 - 00;06;45;21
Nikki Rasmussen
So everything was done fully remotely. And the way that North Bay had organized and planned really lent itself very well to that process. And then we continue with an ongoing support. So we have a regular cadence of meetings in which we discuss data, we discuss the things that are happening at North Bay. We also have a tremendous data analytics team that pulls together some very custom data and then also some standard data reporting that we share with the executive team at North Bay, as well as with the ICU rounders that Natalie's talked about in that team.

00;06;45;21 - 00;07;07;07
Nikki Rasmussen
So it's a great opportunity for all of us that have the clinical background to get together and share the data and the things that are happening and the opportunities for growth and advancement. And we work together very, very closely. We meet every two weeks. So it's a really great relationship of ongoing support and partnership. It really helps with engagement.

00;07;07;08 - 00;07;20;06
Nikki Rasmussen
It really keeps everybody recognizing the importance of what they do to take care of patients and how that has an impact on the overall outcomes and goals of the organization as well.

00;07;20;09 - 00;07;28;20
Natalie Correll-Yoder
And I think what I would add is that it's the same data that the executive team gets, the medical staff, the nursing leadership and the frontline staff.

00;07;28;22 - 00;07;34;04
Natalie Correll-Yoder
So we're trying to be transparent about what we're doing and how the program is going.

00;07;34;07 - 00;07;53;08
Marie Cleary-Fishma
That's really important to make sure the care team is involved across the board. So thank you for that point. So one thing I'd like to just ask for a minute. For all of our listeners, in case anyone isn't familiar, can you just describe the Rothman Index just a little bit in, you know, some brief terms so that folks can at least go look it up more if they want to see more?

00;07;53;10 - 00;08;36;08
Natalie Correll-Yoder
Certainly. The Rothman Index is an algorithm that runs off of nursing documentation, vital signs, and then some selected labs. Dr. Rothman pioneered and developed the Rothman Index, and it is designed to look at key elements that are common to all patients. And so it doesn't cherry pick certain lab work or certain procedures. It looks at basic things that every single patient gets, and then how the nurse documents around the patient assessment and so those elements are really important in identifying subtle changes in the patient, because a lot of times that may be one assessment item or one particular element will change.

00;08;36;10 - 00;09;03;10
Natalie Correll-Yoder
But you don't see it in the big picture of things. And so the Rothman Index allows us to trend the data and then identify which direction the patient's going. So a higher number is actually good. It's kind of inverse of many of the other algorithms that are out there. So a higher number is that the patient is healthier, a lower number is the patient is sicker, and then the algorithm will then send you a warning if there's sudden changes.

00;09;03;12 - 00;09;13;07
Marie Cleary-Fishma
So, Nikki, we've had some description from Natalie about the Rothman Index. Is there anything from the Spacelabs perspective that you'd like to add to that?

00;09;13;10 - 00;09;36;28
Nikki Rasmussen
Well, I think one of the most unique things about the Rothman Index is that it came out of a very personal story. Dr. Rothman himself lost his mother following a very routine procedure. And he and his brother, who are Ph.D. scientists, had taken a lot of opportunity to study in partnership with the hospital where she had passed from.

00;09;37;00 - 00;10;04;18
Nikki Rasmussen
And look at where did we lose an opportunity, where we might have been able to catch her deterioration? Her deterioration was one of those kind of slow, steady deteriorations. And what they identified was that truly the nursing assessments are those leading indicators of change in patients. And if we think about it clinically, that makes sense. Because a lot of times we see those changes happen in patients well ahead of changes in vitals or in changes in lab values, we start to see patients become more somnolent.

00;10;04;18 - 00;10;36;28
Nikki Rasmussen
They start to need more assistance for transfers. They change their eating habits, and we start to notice those things. And that's documented in the nursing assessments. And so they identified that the key elements in that identification of early deterioration lies within the nursing assessment. And I think that's one of the unique things that sets the Rothman Index apart is I think just a, you know, a really great story out of something that was sad became something that was really impactful and is able to save many, many lives.

00;10;37;00 - 00;10;55;28
Marie Cleary-Fishma
That's a great description. Thank you for that. And based on that, then in what you've seen in your experience with rollout, what really what kind of direct impact are you seeing on the care team's ability to really care for patients using that? What have you seen in experience sort of real world kinds of activity?

00;10;56;00 - 00;11;25;00
Natalie Correll-Yoder
Well, when we first rolled it out, it was actually very amazing. In fact, one of my intensivists told me that the Rothman Index probably saved his patient's life because she had been on the floor, had some kind of slow, subtle GI bleeding that hadn't really been identified. And the Rothman Index had a clear deterioration. The ICU rounder went out and saw the patient, got him involved in the patient, got the treatment they needed very timely and then, you know, exit at our facility in a much healthier state.

00;11;25;02 - 00;11;43;27
Natalie Correll-Yoder
And then we've also used it to identify patients that we should maybe transition to palliative care. And so that's been another nice aspect of it, of identifying patients who are having a gradual trend and are not improving. And maybe it's time to really look at what's the best thing for them in the next stage of their life.

00;11;44;00 - 00;11;55;16
Marie Cleary-Fishma
So tell me a little bit about what the future looks like. What's next for North Bay when it comes to patient care goals and technology and A.I. and all of the kinds of amazing things that you're doing?

00;11;55;18 - 00;12;19;18
Natalie Correll-Yoder
I am doing a lot of work in looking at how to reduce our mortality. So since we've implemented the Rothman Index, we did initially reduce our mortality 30%, which was huge for us. We've been able to sustain right around 27 to 30% pretty consistently each quarter around looking at how we're doing and where we've been. And it's a two year rolling calendar, just to give you an idea of the timeline.

00;12;19;24 - 00;12;48;26
Natalie Correll-Yoder
And so I'm trying to look at with my physician partners, looking at what are those patients that we can still rescue, and then what are those patients that we can identify for that transition? And what is it that we can do to best provide the care these patients need? I think as far as the technology piece is, my goal would be to transition the Rothman Index, not just on to the computer and kiosks, which the staff are using now, but onto their hospital cell phones so that the warnings come to them.

00;12;48;28 - 00;12;55;04
Natalie Correll-Yoder
That software is available. It's not quite in our picture yet, but it's one of those things I'm advocating for That's okay.

00;12;55;04 - 00;12;58;04
Marie Cleary-Fishma
Future vision is important, right? It helps us get there.

00;12;58;04 - 00;12;59;14
Natalie Correll-Yoder
Yeah, absolutely.

00;12;59;16 - 00;13;16;13
Marie Cleary-Fishma
So if you were going to tell your colleagues, other folks, hospitals across the nation, what kind of guidance or lessons learned would you share with them to help them be successful with integrating and incorporating predictive analytics and using that to improve the quality of care they provide?

00;13;16;16 - 00;13;43;04
Natalie Correll-Yoder
I think the Rothman Index speaks for itself. And in consistently sharing the data, I've actually gotten a lot of our physician leadership involved and committed to the Rothman Index as a as a solid tool. We're looking at incorporating it into other domains of really working with the palliative care team to identify that. And then I think I want to get it more into some of our readmissions and care management work.

00;13;43;07 - 00;14;07;06
Natalie Correll-Yoder
I think some of our lessons learned would be you cannot reinforce new technology often enough. And so with any new thing, there is a learning curve for the whole organization. And I think COVID has brought us a lot of staff turnover. Folks have transitioned out of health care for a variety of reasons. COVID was a very difficult time for many of us.

00;14;07;09 - 00;14;18;21
Natalie Correll-Yoder
Lots of staff have suffered burnout and then we have a lot of new staff. And so that ongoing education and training and putting resources into that, you cannot underestimate the importance of that for sustainability.

00;14;18;23 - 00;14;34;21
Marie Cleary-Fishma
So, Nikki, could you give me the perspective from Spacelabs on what guidance or lessons learned that you would share with others who are listening, listening to this now and who might be interested in pursuing some kind of predictive analytic tool in their patient care models?

00;14;34;23 - 00;15;10;04
Nikki Rasmussen
Oh, that's a great question too. I think the important thing to think about is that there's no time like the present. You know, there's always going to be something that's going to come up that you think about, Oh, we can't do this now. Let's do it later, or Let's do it in a year or two. And I think the more that you can just figure out how to plug it into the existing circumstances with our help, certainly that's one of the things that we do as the part of the customer success team is help to identify and break down those barriers and help a client grow and adopt and find a way to make something

00;15;10;04 - 00;15;37;25
Nikki Rasmussen
like this successful in their organization. So I think that and to Natalie's point to talking about education, that you've got to have that sustained education plan. You know, we know in health care there's a lot of turnover. Things move very quickly. So we need to have that sustained plan in place for how we're going to continue to make sure that everyone who comes into the organization has the same education and the same knowledge base moving forward as those who've been part of the organization for a period of time.

00;15;37;28 - 00;16;10;06
Marie Cleary-Fishma
So that makes me think of one more question I'll sneak in really quickly, and that is about workforce. You talked about the turnover and in bringing in younger, newer clinical staff and care providers. Does it help them feel more comfortable and confident to know they have this kind of a tool or resource that will help them if maybe they're not quite seeing everything right away, that they have this backup sort of something that will give them additional data to support the care decisions they're making.

00;16;10;08 - 00;16;12;11
Marie Cleary-Fishma
How does that look?

00;16;12;14 - 00;16;33;19
Natalie Correll-Yoder
Yeah, I think that the the more senior staff value that and utilize it for that purpose. We do a daily safety call with the organization and many of the managers will report on the call that they're monitoring two or three patients on their unit that have either warnings or trends that they need to pay attention to. So I think that's really helpful.

00;16;33;21 - 00;17;01;12
Natalie Correll-Yoder
I think the number of new staff because we're hiring a lot of new grads or people new to acute care from nursing homes, that there's a challenge there and trying to get them up to speed and learn the role that in there. If you look at, you know, business model of competency and development and where people are in that learning, I think the new staff are still learning how to use the tool. But they do rely on the rounder and they go to the rounder for that information.

00;17;01;18 - 00;17;07;11
Natalie Correll-Yoder
So the rounder will get those questions and then they're doing a lot of mentoring with a lot of our newer staff.

00;17;07;12 - 00;17;15;13
Marie Cleary-Fishma
That's great. Yeah. So it's that combination of technology and the personnel knowledge and knowing they have somebody as a resource to go to.

00;17;15;14 - 00;17;16;00
Natalie Correll-Yoder
Absolutely.

00;17;16;00 - 00;17;36;00
Marie Cleary-Fishma
That's great. That's wonderful. You've highlighted a quite a few patient safety best practices today as we've had this conversation. So congratulations for all of that and the data you shared and the trends you're seeing in your reduction of mortality. Really, really well done. So we've heard a little bit from Natalie about the future for North Bay health.

00;17;36;03 - 00;17;41;05
Marie Cleary-Fishma
Nikki, what can you tell us about the future for Spacelabs health care?

00;17;41;07 - 00;18;03;07
Nikki Rasmussen
Oh, that's so exciting. There's so much happening. I feel like things are moving at the speed of sound over here, which I guess it kind of makes sense given our given our name of Spacelabs. But we are really moving forward into how to integrate the Rothman Index tool in with some existing other Spacelabs tools, some other software and patient monitoring

00;18;03;07 - 00;18;20;28
Nikki Rasmussen
that's happening over here. There's a lot of work right now in the data and really what the data can tell us and how we can continue to build tools that have that predictive capability and are able to identify risk in patients before things get too late.

00;18;21;01 - 00;18;37;20
Marie Cleary-Fishma
It's all about the data and the patients and what we can do to help them. So Natalie and Nikki, thank you so much for joining us today and for sharing all of your insights and thoughts and the great work that you've been doing. If you'd like to learn more about Spacelab's health care, please visit www.spacelabshealthcare.com.

Predictive Data Modeling

Analytics & Research

Quality & Patient Safety