Healthcare is undergoing a profound digital transformation, but too often, the burden of that transformation falls squarely on the shoulders of the people with the least bandwidth to absorb it: nurses.
I’m excited to launch this blog series on Healthcare Communication Orchestration, where I’ll explore the evidence, challenges, and solutions that can empower clinical teams to work smarter—not harder. In this first installment, we focus on one central message:
Nurses should not be middleware.
They should not be forced to manually bridge disconnected systems, decipher uncoordinated alarms, or orchestrate communication between multiple teams while also delivering safe, compassionate patient care. Yet today, these expectations have become the norm.
Evidence That Demands Action
A growing body of research underscores why this issue is urgent:
- Poorly designed technology increases the risk of nurse burnout.¹
- Nurse burnout correlates with worse clinical outcomes.²
- Nurses need to master upwards of 70 bedside devices and technologies, creating a real risk that clinicians end up caring for computers instead of caring for patients.³
- Alarm fatigue remains pervasive, raising a real concern for missing salient alerts over nuisance alerts.⁴
These findings ring true in the real world. As both a Hospitalist and the son of aging parents, I have witnessed the cacophony of modern care: relentless beeps, pings, messages, devices, applications, and alarms—each competing for attention.
This reduced signal-to-noise ratio leads to cognitive overload. Layer in rising incivility, staffing strain, and workflow fragmentation, and we have unintentionally created what I call “induced technostress.”
Despite these pressures, nurses are often expected to simply “figure it out.” A concrete manifestation of this is the poor ergonomics of multiple bar-code readers in the same room, each serving a different purpose. Some organizations have made impressive strides through simulation labs and nurse-driven informatics innovation. But as an industry, we can and must do more.
A Better Path: Healthcare Communication Orchestration
Digital tools, when deployed intentionally and cohesively, have advanced enough to meaningfully reduce this burden. They can “orchestrate” healthcare communication for nurses, helping to restore control of their workflows and focus on patient-centered care.
Four Ways Healthcare Communication Orchestration Transforms the Clinical Experience:
- Hands-Free, Role-Based Communication
Voice-activated systems can automatically target the correct roles and teams on the first attempt, eliminating phone tag, manual directory searches, and guesswork. - Smarter Alarm Management
Integrated, intelligent alerting can filter out non-urgent notifications, routing them to the appropriate care-team members—often redirecting low-acuity tasks away from nurses entirely. - Ambient AI Scribes
Hands-free ambient documentation reduces charting burden and allows nurses to maintain a continuous presence at the bedside. - Smart Room Integration
A truly responsive, intelligent care environment that combines voice, sensors, displays, and team coordination can extend the capabilities of the care team and support emerging models such as virtual nursing and remote sitters.
The encouraging reality:
- These technologies already exist.
- When orchestrated strategically, they drive measurable ROI, such as reduced RN turnover, fewer adverse events, decreased overtime, and improved patient throughput. I’ll explore these financial and organizational benefits in future posts.
A Realistic Example—Enabled Today
Consider how this might unfold in practice.
Nurse Alex receives an alarm notification by text: patient Charlie may have a cardiac arrhythmia. Before Alex reaches the room, the telemetry technician who was also alerted, texted to confirm their suspicion for SVT vs. rapid afib. Alex checks the monitor strip image and enters the Smart Room to see Charlie.
The digital footboard in the Smart Room recognizes Alex’s arrival through RTLS integration and announces Alex’s arrival in the patient’s preferred language via a notification on the digital display.
Charlie: “Hey Alex, I ordered my lunch, and they cleaned up my spilled protein shake from last night.”
Alex: “Great. I saw that get completed by those teams as it was happening. I’m here to check out a recent alarm from the cardiac monitor you’re wearing. Since the other monitors and video indicate you weren’t moving in the bed, it appears real. Are you having any palpitations or chest pain?”
Charlie: “Both. Will this keep me from going home today?”
Alex: “Yes, Charlie, we’ll need to get that worked up before you can go. I see on the digital whiteboard that you have a history of angina and CHF. And the rhythm strip I saw on my way here showed a high heart rate.”
As Alex begins her assessment, she engages the Smart Room via a hands-free badge with on-board Ambient AI:
Alex: “Hey, <Smart Room Agent>, please get an EKG machine to this room. Also, please alert the Hospitalist, and the Cardiac team of chest pain in the setting of rapid heart rate.”
The Smart Room engages a workflow orchestration engine to coordinate each of the three communication actions, using roles, teams, and closed-loop communication channels to communicate to the right person in real time.
<Smart Room Agent>: “Excuse me Alex and Charlie – the EKG machine is on the way. Dr. Jones is the covering Hospitalist and will be here shortly. The Cardiology team is reviewing the telemetry strip and will check the EKG once complete. They’ll also arrive soon. Would you like me to place the order for the EKG in the EHR, enter an event note, and activate the digital sign outside Charlie’s room per protocol?”
Alex: “Yes to all three. Charlie, we’re on top of this.”
Within seconds, the Smart Room initiates each action.
This scenario demonstrates the power of orchestration:
- Routine, low-acuity tasks are removed from the nurse’s workload.
- High-acuity situations trigger streamlined, protocol-driven responses.
- The room becomes an active member of the care team.
- Data flows to dashboards that support operational insight and continuous improvement.
This isn’t tomorrow’s vision. This is achievable today.
What’s Next
In the next post of this five-part series, we’ll explore “Disordered Communication—Still a Problem” and why uncoordinated communication continues to undermine clinical care.
PS – Physicians, NPs, and PAs also should not be middleware. We’ll talk about that too.
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