Marc and Laura Andreessen Adult Emergency Department at Stanford Health Care

Palo Alto, California

Through its shared-governance triage task force, nurses at the Marc and Laura Andreessen Adult Emergency Department at Stanford Health Care identified delays in obtaining STAT EKGs for patients with cardiac complaints. The team redesigned the front-end triage process in the 66-bed department by implementing a Quick Look Nurse role, relocating registration, streamlining patient flow and empowering nurses to initiate STAT EKGs on clinical assessment. Across 7,816 cardiac-related encounters, the median door-to-EKG time decreased from 10.0 to 6.3 minutes, a 37 percent reduction sustained for eight consecutive quarters. The initiative was presented at the 2025 ENA conference and selected as a Magnet exemplar.

The department, which saw more than 83,200 patient visits last year, also transformed care for older adults, who account for about 28,000 visits annually. A nurse-led Geriatric Emergency Department workgroup identified that older adults requiring non-violent restraints were spending an average of 85 percent of their ED stay restrained. The team implemented safety companions, tele-sitters, proactive rounding and Age-Friendly Health System 4Ms principles focused on mobility, mentation, medications and what matters most. The average time spent in non-violent restraints decreased from 85 percent of their stay to zero. This work contributed to Level 1 Geriatric Emergency Department Accreditation.