As skilled nursing facilities care for increasingly complex patients, consistency in clinical workflows is essential. Differences in admission orders, laboratory notification parameters, medication holding instructions, and sliding-scale insulin protocols can create confusion for nursing staff and generate unnecessary calls to providers.

Our group recently began admitting patients to a facility where most residents are managed by another physician group. We quickly noticed frequent calls regarding order clarification, routine laboratory values, and admission orders—often several times per shift. For example, one group’s holding parameters for antihypertensives differed meaningfully from ours [e.g., “hold metoprolol for SBP <100 vs. <90”], leading nursing staff to call for clarification on nearly every shift change. This pattern prompted us to sit down with facility leadership and the other physician group to review where our approaches diverged and where alignment made sense.

That conversation became the starting point for a broader effort: physician groups and facility leadership including the medical director working together to establish common practices for issues such as abnormal lab notification thresholds, sliding-scale insulin orders, blood pressure medication holding parameters, and routine admission laboratory testing when appropriate. Periodic review of these standards helps ensure continued agreement among providers as practices and patient populations evolve.

We recognize this isn’t always simple—different EHR templates, individual physician preferences, and varying comfort levels with shared protocols can all slow adoption. But even partial standardization, focused on the highest-volume sources of calls, can meaningfully reduce friction.

While clinical judgment should always guide individual patient care, standardized orders can reduce confusion, decrease unnecessary calls, improve communication, and support more consistent, high-quality care for residents. Facilities interested in exploring this can start small: convene the physician groups working in the building, identify the two or three order categories generating the most calls, and agree on a shared baseline for those alone.