Care delivery is steadily shifting beyond traditional acute care and inpatient settings, as more procedures and services move to outpatient clinics, ambulatory surgery centers, and home-based care. Research shows that a significant share of hospital volume is transitioning into lower-cost settings, reshaping where care is delivered and how nursing teams are structured.
With this expansion of alternative sites of care, nurses play a crucial role in maintaining care continuity during transitions. And in non-acute environments, nurses are relying more heavily on independent clinical judgment to ensure safe, effective patient care.
Responding to the need for consistency, the American Hospital Association (AHA) Care Delivery Transformation Framework helps hospitals and health systems rethink how care is delivered across clinical and community settings to better meet patient needs while supporting long-term sustainability.
The Framework provides a visual model and curated resources showing how foundational principles, operational infrastructure, and care delivery strategies — such as team-based care, technology-enabled care, community partnerships, and telehealth — can be aligned to design and implement innovative care models. The Framework is intended to guide organizations in planning and executing care delivery changes that improve coordination, accessibility, quality, and the overall care experience across the continuum.
Why are consistent clinical decision support tools critical to support care across settings?
For nurse leaders, translating the AHA Framework into practice requires ensuring that the structures supporting nursing care are aligned across every setting in which care is delivered.
- Nursing practice should be supported by evidence-based workflows, consistent documentation standards, and clinical tools tailored to specific care environments, while grounded in shared policies and procedures.
- When standards and guidance are aligned across settings, nurses can move with greater confidence and consistency as patients transition between environments. A shared clinical foundation reduces unnecessary reorientation, supports continuity, and reinforces high-quality care across the continuum.
- Consistent documentation requirements, coordinated clinical procedures, and shared access to evidence-based guidance help ensure that care is delivered in a reliable and cohesive manner, regardless of setting. By aligning practice across inpatient, outpatient, home, and virtual settings, nurse leaders create the conditions for consistent practice, stronger coordination, and sustained patient safety.
Three actionable strategies for addressing the challenges of providing care across the continuum
As nursing roles expand beyond the inpatient bedside, nurse leaders are called on to scale new care delivery models across care settings. There are several strategies that nurse leaders can take to support consistent, high-quality care delivery across the care continuum.
1. Standardize access to best evidence across care settings
As nursing practice moves beyond traditional inpatient settings, guidance can often be inconsistent, with nurses encountering different standards or expectations. This creates a need to reorient as patients move across settings, contributing to added cognitive burden and inconsistent practice, particularly during transitions of care.
Nursing leaders can reduce variation in care as patients move between environments by establishing standardized, evidence-based practices. This ensures nurses are working from the same evidence base regardless of care setting or delivery model.
Standardization provides a shared clinical foundation so that nurses are able to apply best practice with confidence across settings, without demanding adherence to rigid protocols or restricting the application of their own clinical judgment. When evidence-based guidance is coordinated across the continuum of care, nurses can focus on applying their expertise in context rather than searching for information.
2. Embed decision support into nursing workflows
Studies indicate decision support tools are more likely to be used and trusted when they are designed to integrate seamlessly with clinician workflows rather than exist as a separate system. This ensures that relevant guidance is available at the point of care, without disrupting workflows or undermining professional judgment. This is an important way to reduce variability in care and reinforce safe, consistent practice.
Embedding clinical decision support systems into everyday nursing workflows — and ensuring that guidance follows nurses across settings — gives nurses access to diagnostic tools, treatment protocols, and patient-specific recommendations wherever they are, in seconds.
Research suggests that clinical decision support (CDS) tools in these environments can improve clinical decision-making and workflow more efficient. Yet, adoption and integration into routine nursing practice remain uneven and not well-aligned with how nurses actually work across care environments. This challenge occurs not only in inpatient settings, but also in ambulatory and other non-acute care contexts.
Addressing this gap requires a shift in the way guidance is delivered. Clinical decision support — including evidence-based guidelines, care pathways, and other decision aids — should be embedded within nursing workflows, so that relevant guidance follows nurses as their care settings change. For nurse leaders, this is a practical way to reduce cognitive burden and reinforce consistent practice without undermining clinical judgment.
3. Make continuity of care a leadership priority
Evidence has shown that continuity of care is a core component of quality measurement across diverse care environments and depends on consistent communication, shared standards, and aligned clinical goals among providers. As care extends across acute, ambulatory, virtual, and home-based settings, maintaining continuity directly influences patient outcomes and reduces the risk of errors during transitions between care environments.
Sustaining quality across settings therefore depends on how continuity is built into the design of nursing workflows. Nurse leaders must treat care continuity as a function of how nursing support is designed and delivered. When access to evidence, guidance, and decision support varies by care setting, nurses are forced to reorient themselves repeatedly, which introduces variability in practice and increases the risk of missed or delayed decisions during transitions of care.
Designing care continuity as an organizational responsibility means ensuring that nursing support remains consistent regardless of how or where care is delivered. By aligning procedures, standards, expectations, and support mechanisms across care environments, nurse leaders can reduce reliance on workarounds and individual heroics, allowing nurses to focus their expertise where it matters most: on patient care and clinical judgment.
As care delivery extends beyond traditional inpatient settings, the demands continue to grow in complexity. What’s needed is a concentrated focus on consistency, ensuring that access to evidence, decision support, and continuity of care do not vary based on where or how care is delivered.
For nurse leaders, this means rethinking how nursing support is designed and sustained across care environments. By standardizing access to evidence, embedding guidance into everyday workflows, and treating continuity as an organizational responsibility, leaders can reduce unnecessary burden on the workforce while reinforcing safe, high-quality practice.
As care models evolve, organizations that invest in aligned, evidence-based support will be better positioned to sustain both quality outcomes and the nursing workforce itself.
Learn how Lippincott® Solutions can help nurse leaders standardize evidence, embed decision support, and sustain care continuity as patients move across settings.
