Emergency department leaders at Sutter Medical Center examined the issue of ED boarding when they determined many patients occupying in-patient beds were waiting for diagnostics and

Sutter Medical Center, Sacramento

then discharged. The most consistent delay was for patients waiting for a cardiac stress test. The team created a clinical decision area for these types of patients to expedite their care, leaving inpatient beds open for sicker patients. The trial period lasted four months and was ultimately implemented as a permanent change based on the successful reduction in length of stay and decreased use of in-patient beds.

The team in the 54-bed ED also focused on improving triage accuracy by identifying information specific to communication, cultural aspects and providing immediate interventions. The competency process used a virtual reality artificial intelligence online program. Nurses were asked to triage the virtual patient using an electronic health record test environment which incorporates communication to the provider and identifies cultural and ethnic variables. The virtual patient model was displayed on an adjacent computer screen and provided auditory responses using a large language model trained on health care training data and scenario specific context developed for this pilot. Further modules will incorporate more cultural variables.