Bob Luttman, Robert Luttman & Associates
(Briefly) Revisiting VMS Design Issues
Gateway Model
Gateway Documentation - Normal Days
Gateway Documentation - Insert Days
Gateway Model
A complete model of variances looks like this:
- Detail Variances are exactly that, all of the tasks and outcomes (intermediate and discharge) on the pathway.
- Critical Variances are the most important tasks and outcomes. A variance here is a sign of either poor patient care or significant change in patient condition.
- Gateway Variances we have discussed, they are the key milestones in the care process.
One important question before we talk about this model in more detail:
How do Gateway Variances differ from Critical Variances?
Critical variances are more explicitly related to the quality of care. They are the things we are worried about no matte how long the patient has been in a particular nursing unit: pain management, nausea, extubation, ambulation, patient teaching, etc.
Some of these are used as gateways. Most are causes of gateway variances. To a great extent the classification is up to you or depends on the specific pathway.
The idea is that both are important (they answer the So What question). Gateways are a higher level view, critical variances a deeper cut.
Gateway variances tell you where to drill and critical variances are what you are drilling for. Detail variances are what you drill through.
Recording vs. Abstracting Data
As the model shows, all variances are recorded in the patient documentation. For analysis purposes, however, you only need to abstract and store the critical and gateway variances. If you need the detail variances they remain accessible in the patient chart.
