Is The Rothman Index Better Than The NHS Early Warning System Or Better Than Clinician Judgment – Thoughts From Dr. Farkas

I’ve just reviewed Dr. Farkas‘ post PulmCrit- The Rothman Index: Artificial intelligence or merely a symptom of a broken healthcare system?
January 25, 2020 by Josh Farkas from PulmCrit.

Dr. Farkas post is, as always, an outstanding teaching resource on medical decision making. [Note to myself: Read it again. It is brief and totally worth the minimal time investment.]

Here are excerpts from Dr. Farkas post:

We are constantly hunting for newer and better sources of information. This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools. Some of these pan out. Most don’t.

Why are these new sources of information generally disappointing? The answer is simple: we’re already doing pretty well. In order for a new source of information to help us, it needs to represent a substantive improvement over what we already have. We don’t need more information (that’s just noise) – we need better information.

This principle was illustrated by the above article comparing various decision instruments versus clinician judgement.​1​

Decision instruments generally perform well as a stand-alone tests.  However, when compared to the judgement of treating physicians, decision instruments seldom add anything.  This shouldn’t be surprising.  Decision tools are terrific at processing a few bits of information, but they ignore lots of other information.

Although the Rothman Index requires lots of data entry time from nursing staff (thus lessening the time the nurses have to monitor and assess the patient for deterioration), Dr. Farkas states that the Index is not superior to the NHS Early Warning System*. And the Rothman Index is not superior to an intern’s clinical judgement.

*Sick Or Not Sick? Resources On The National Health Service Early Warning Score (NEWS and NEWS2)
Posted on October 7, 2019 by Tom Wade MD

*For information on the Pediatric Early Warning Score, please see:

our system has problems, but Rothman Index isn’t the cure

There is an alternative, and perhaps better solution:

  • Don’t use the Rothman Index.
  • Stop forcing nurses to spend half their time documenting in the electronic medical record.  Let nurses be nurses, not data entry technicians.
  • Work on improving communication between nurses, physicians, and rapid response teams.  Nurses should be empowered to activate a rapid response team or call for help based on their best judgement – without needing the Rothman Index to back them up.
  • Pre-emptively rounding on the sickest patients in the ward is a terrific idea but this, again, can be done perfectly well without a Rothman Index.  You don’t need the Rothman Index to know which patients are the sickest –  just ask the closest intern!

Thank you again, Dr. Farkas.

This entry was posted in Medical Decision Making, Pulmcrit by Dr. Josh Farkas. Bookmark the permalink.