An alert nobody closes is a miss.
Closur is early deterioration surveillance for skilled nursing facilities. A registered nurse validates every signal against the record before it reaches a clinician, and every finding stays open until it reaches a documented outcome.
Every signal gets a name, a time, and a destination.
One finding, start to finish Long-stay resident, east hall
- Tue 06:10
Surfaced. Intake down two days running. New confusion charted on nights.
- Tue 08:40
Validated. RN reviewer confirms it in the record: meals at 25 percent, no new orders.
- Tue 08:55
Routed. Sent to the Director of Nursing and the attending NP, evidence attached.
- Tue 11:20
Disposition. NP orders labs and fluids, chooses to monitor. An observation period opens.
- Wed 08:30
Still open. Labs are back and abnormal. Returned to the NP in the morning review.
- Fri 08:35
Closed. Intake recovered, confusion resolved. Outcome recorded: stabilized in place.
Illustrative example, not resident data. External records show roles, never names.
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A nurse reads it firstAn RN checks every signal against the record before anything is sent.
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Someone owns itEach finding carries a named role, a time, and a destination.
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It stays open until it's overResolved, stabilized, or transferred, with the outcome documented.
The early signs are already in the chart.
Facility staff document these things every day, and the systems they chart in fire alerts about them. What goes missing is ownership.
The alert lands on a busy shift. The shift changes. By morning nobody can say who saw it or what was decided, and the resident is sicker by the time anyone looks again.
- Nursing note02:14
A temperature the night after a hospital return.
Alert fired. No owner. - Meal intake recordDay 2
Intake that has slipped two days in a row.
Alert fired. No owner. - Lab order36 hours old
A lab that was ordered and never drawn.
No alert at all.
Fired is not seen. Seen is not closed.
Most alert systems count the first row. Closur is built around the last one.
Illustration, not measured data. Putting real numbers on these three rows, building by building, is the first job of a Closur pilot.
How a signal becomes a closed finding.
Software finds the signals. A nurse decides which ones deserve a clinician's time. The clinician decides the care. Closur keeps the record of all three.
- Closur software
Surface
Closur reads the clinical documentation your building already produces each day and picks out changes that tend to come before a decline.
- RN reviewer
Validate
A registered nurse checks each signal against the resident's record. Signals that don't hold up stop here and never cost your staff a minute.
- RN reviewer
Route
A validated finding goes to the person who can act on it, the nurse leader or the provider, with the evidence attached.
- Your clinician
Disposition
The clinician decides. Closur records who, when, and what. Choosing to monitor opens an observation period. It does not close the finding.
- Reviewer and clinician
Outcome
The finding stays under daily review until the episode is resolved, stabilized, or transferred, and that outcome is documented.
Open loops come back every morning.
Closur doesn't page people through the night. It keeps the ledger, and each building starts the day with a short list: what is new, what is still open, and what closed since yesterday.
Facility staff and providers can look at the list any time someone asks a question. They see it read-only. The resident's record stays where it has always been.
- Rm 114Intake down, new confusionAttending NP, labs pendingOpen, day 2
- Rm 207Temp 100.8 after hospital returnDirector of NursingNew
- Rm 122Fall, on anticoagulantAttending MD, neuro checks orderedObserving
- Rm 310Ordered lab not drawnCharge nurseOpen, day 1
- Rm 215Weight loss, new edemaOutcome: stabilized in placeClosed
Product concept with made-up data. Rooms and roles only, no names.
What Closur doesn't do.
Buildings don't need more alerts. These are the lines we hold so that Closur takes work off the floor instead of adding to it.
- It doesn't send raw alerts.
- Nothing reaches a clinician until a nurse has checked it against the record.
- It doesn't diagnose or direct care.
- Assessment and every care decision stay with the licensed clinicians responsible for the resident. Closur routes, records, and follows up.
- It doesn't chase your staff through the shift.
- Open loops come back in the next morning review, and the volume is sized to what the building can actually work.
- It doesn't rotate strangers through your buildings.
- Each nurse reviewer keeps the same set of buildings and gets to know the leadership and charge nurses in them.
Three groups share one resident. Closur gives them one record.
If you operate buildings
You get a standing record that each signal was seen, reviewed by a nurse, sent to someone, and followed to an outcome. It is there when a family member, a medical director, or a surveyor asks what happened and when.
If you round in them
Physicians and nurse practitioners covering several buildings can't sort through every alert each one generates. Closur sends you findings a nurse has already validated, with the evidence attached, and records your disposition with your role and the time.
- Meal intake 25 percent, Sunday and Monday
- Night nursing note, new confusion
- No change in orders since admission
If you carry the risk
Health plans, I-SNPs, and ACOs pay for the transfer that could have been treated in place. Closur gives a risk-bearing partner daily, nurse-reviewed visibility into residents after admission, and a record of what was done about each finding.
We grade ourselves on closure, not on model accuracy.
A model can be right about a resident and still change nothing. These three numbers tell you whether something happened.
- ClosureOf the findings we route, how many reach a documented outcome.
- Time to actionHow long it takes to get from a signal surfacing to a clinician's disposition.
- Burden per nurseHow much we ask of the facility's nurses each day. We cap it to what the building can staff.
Closur is built by Pleros Health.
Pleros Health is the company behind the Closur platform. Closur begins with clinical deterioration. Closur Quality, now in development, applies the same review-and-closure model to regulatory and survey readiness.
Matt Hearn, RN
Founder
Matt has spent forty years in long-term care nursing. He started as a nursing assistant, became a Director of Nursing, and moved into clinical informatics.
He has worked with facility alert systems firsthand for a decade and watched good alerts go unanswered. Closur is built on what that taught him. Finding the signal was never the hard part. Closing it was.
Let's talk about your buildings.
We are arranging our first pilot buildings now. If you run skilled nursing facilities, round in them, or carry risk for the residents in them, we would like to hear how alerts get handled where you are.