Kaiser Permanente Emergency Department Sacramento Medical Center

Sacramento, California

The Kaiser Sacramento Emergency Department team leveraged shared governance and collaborative decision-making to design and implement a practice change that significantly improved the identification and management of patients presenting with dizziness. This process enhanced early stroke recognition, improved door-to-imaging times and ensured rapid intervention, ultimately improving patient outcomes. A practice change was implemented to standardize the triage and assessment protocol, enabling ED nurses to rapidly differentiate benign causes of dizziness from potentially serious neurological conditions such as stroke. This practice change identified an additional 380 patients, with seven of these receiving thrombolytics. This outcome highlights the profound value of early detection and collaborative care.

Over the most recent 12 months, the 59-bed ED prioritized restraint reduction, with a specific focus on improving care for behavioral health and psychiatric patients. Training in verbal de-escalation techniques and crisis prevention strategies was increased, with an emphasis on practical skills that could be immediately applied at the bedside. The department implemented and reinforced the use of Code Grey as an early, proactive team response to potentially violent or combative situations. This approach improved situational control, reduced staff safety concerns and created space for less restrictive interventions to be attempted first. As a result of these efforts, the department saw a 13 percent reduction in use from 2024 to 2025.