Shared governance and collaborative decision-making enabled emergency department staff at this 8-bed critical access hospital to improve care for acute stroke patients by identifying and

Santa Ynez Valley Cottage Hospital Emergency Department

addressing unnecessary transfers for MRI imaging. Through interdisciplinary collaboration, staff proposed extending local MRI hours and implementing post-MRI tele-neurology re-evaluations which allowed more patients to receive comprehensive care closer to home. Leadership supported the initiative, leading to updated workflows, staff education and streamlined communication. Since implementation in August 2025, of 12 stroke patients receiving local MRI, eight were discharged to their home, one was directly admitted and only three required ED transfer. The changes improved patient satisfaction, reduced transfers and enhanced resource utilization.

Additionally, ED nurses at Santa Ynez Valley Cottage Hospital partnered with local EMS to address social determinants of health affecting geriatric patients by implementing the Physical Environment Assessment Tool. During EMS responses, paramedics assess patients’ living environments for safety risks, social support, cleanliness and hazards. PEAT scores are communicated to the ED and documented in the EMR. Patients with moderate to high-risk scores automatically receive case management referrals for things such as home health, transportation, food assistance, housing support or protective services. This collaborative effort improves identification of unsafe living conditions, strengthens coordination between health care and community resources and supports better outcomes for vulnerable older adults.