Bob Luttman, Robert Luttman & Associates
(Briefly) Revisiting VMS Design Issues
Gateway Documentation - Normal Days
Gateway Documentation - Insert Days
Gateway Documentation - The Insert Day
Let's go back to the traditional pathway format. When the patient's stay extends beyond the pathway's limit the patient "falls-off" and the pathway is discontinued.
Not a very good documentation system.
The Gateway System uses an insert day format. It looks very much like the normal day document with two exceptions:
- On the top is a data collection area that captures the gateway variance cause.
- You can preauthor the insert days for common conditions. For example, you cannot extubate the patient as planned and that will prolong the ICU stay. You could preauthor insert days for this and use them to document the patient's care.
An example insert day appears below. Again, for a larger picture click here.
The care team can continue documenting patients using this format indefinitely. Note; The usual practice is to consider the patient to have "fallen-off" after two days (at each gateway) for statistical reasons.
The advantages are:
- Maintains the same format as the normal pathway documentation
- Seamlessly, almost effortlessly, captures the gateway variance data.
- Clearly indicates that the patient has deviated significantly from the pathway, and - more importantly -why.
- Facilitates communication about the variance(s) between the care team members.
