Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2018


Doctor of Nursing Practice (DNP)

Primary Advisor

Cathie E Guzzetta, Ph.D., RN, FAAN; Qiuping Zhou, Ph.D, RN


Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The RI scores were significantly higher on admission compared to RI scores at time of rapid response or cardiopulmonary resuscitation event (p<0.001). The RI scores at 48 hours prior to event were significantly higher compared to the scores at event time (p<0.001). RI scores at 24 hours before the event were significantly higher compared to the RI scores at event time (p<0.001). No differences were found between the RI change scores in patients who died and those who remained alive (p=0.83).

Conclusions: Differences existed in RI scores from admission, 48 and 24 hours prior to the time of emergent events. Earlier identification of patient condition changes through the nursing process, combined with an integrated early warning system in the electronic medical record, may reduce emergent events in medical-surgical patients. A collaborative dialogue between nursing and medical staff is crucial to timely recognize and treat conditions to minimize opportunities for emergent events.

Open Access




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