Wednesday, June 8, 2011

Future Patient Care Delivery Committee: Transparency

Today we hear a lot about transparency. In health care this often refers to public awareness: patients and our communities being aware of stats related to specific quality bundles or core measures.

As we consider the guiding principles for Future Patient Care Delivery around coordination of care and patient safety, it becomes apparent that sharing real-time information among care team members is crucial. Transparency of current status of care could affect the provision of evidence-based best practice care and care coordination within the health team to improve patient outcomes. Think about it – today reports are available to us retrospectively, telling us what we did not do. We need to request and expect that our clinical information systems give us current information so that we can change patient outcomes, driving safety and coordinated care into our practice, in real time.

Bringing real-time transparency into care activities that are yet to be delivered could ensure better compliance to protocols or clinical paths by allowing other care team members to have insight into what still needs to be accomplished on a given patient. As an example, take the stroke core measure around giving an antithrombotic by 48 hours for a patient with a documented history of atrial fib. Leveraging our IT systems to show the care team, not just the staff nurse, that the medication is not yet given and the time window in which to do it is narrowing could change practice. This could drive care prior to ‘non-compliance’ in a situation where that patient’s RN is consumed with care of another patient. And research has shown that following the evidence yields better patient outcomes.

The work environment of the care team in acute care settings today needs the support of innovative technology to help ease the burden of ever increasing quality metrics and tasks to perform. Linda Q. Everett, PhD, RN, in the March ’11 Voice, “Leveraging Technology for the Future of Nursing Care Delivery” discusses the complex environments of acute care settings in which a high number of tasks are performed and interruptions are common.

The next step for care delivery is transparency into real time status of key care measures so that patient care can be directed in the moment and there is less reliance on human nature to remember every detail in a complex and interruptive workflow.

1. Define the data that is needed, and
2. Work with IT to provide real-time transparency into this information.

This information could change patient outcomes and actually help the clinician provide care the way it should be: the best care known by the evidence, for all our patients, all the time.

Catherine Whelchel, BSN, RN, MHSA NEA-BC


  1. What about transparency for the patient/family? How can the clinician share the real time documentation with the patient? "We seek to prevent complications of central lines, therefore we are doing x,y,z. See we document that here. This is how our unit/ organization does with this... compared to other organizations"

  2. The comment above was posted on behalf of Danny van Leeuwen, Opa, RN MPH, CPHQ, Senior Project Manager atChildren's Hospital Boston.

  3. Real time transparency is a great goal, but very difficult in current software realities.