MUSC Ashley River Tower Emergency Department
Charleston, South Carolina
MUSC Ashley River Tower Emergency Department
The MUSC Ashley River Tower Emergency Department implemented a Virtual Provider In Triage program in January 2024. VPIT is managed by an attending physician and nurse manager providing dual oversight. Staffed remotely by a physician assistant from 10 a.m. to 8 p.m., five days weekly, VPIT uses dedicated triage rooms equipped for virtual patient evaluations. Providers conduct medical screening exams, place orders and communicate with onsite staff through the EMR. Since implementation, VPIT has improved identification of abnormal results, expedited EKG interpretation and patient disposition, increased patient satisfaction and reduced LWOT rates by over 50 percent.
The team also addressed the key patient safety concern of blood culture contamination, which can lead to unnecessary antibiotic use, return visits and avoidable hospital admissions. Since 2015, the 22-bed Ashley River Tower ED has used a blood culture diversion device to reduce contamination, but inconsistent utilization led to only limited success. In 2023, the unit Clinical Practice Nurse Expert led a comprehensive improvement initiative that included staff education, annual competencies, real-time audits, chart reviews and immediate feedback. Staff identified stocking barriers, prompting bedside placement of devices. Contamination rates improved significantly, falling below 2 percent by the end of 2025, the best performance in the health system.