Medical University of South Carolina (MUSC) Health is testing a new model for emergency department arrivals that brings doctors and nurses to patients before they reach a treatment room. The Charleston-based health system is integrating virtual nurses into the ED arrival workflow alongside its Virtual Provider in Triage (VPIT) program. This collaboration with VirtuAlly, a nurse-led virtual care company spun out of MUSC, aims to address long wait times and crowding that have plagued emergency departments for decades.
Parallel care to reduce wait times
The traditional process often leaves patients sitting in a lobby for hours before speaking to a nurse or a doctor. Patients now undergo intake and evaluation simultaneously through virtual channels. This parallel workflow allows lower-acuity patients to be discharged directly from the front of the department. It also lets bedside nurses focus on care that requires their physical presence while virtual staff handle documentation and initial assessments.
The model requires distinct tasks for the on-site and virtual teams to function smoothly. According to Dr. Jeanhyong “Danny” Park, the ground team and virtual staff must own specific responsibilities so they can work together without constant prompting. A secure chat within Epic serves as a communication pipeline for these teams. Before launching the program in new locations, the on-site and virtual staff hold huddles to align on their approach. This ensures that all members of the care team are on the same page for every single patient.
Implementing the system across different locations has presented logistical challenges. Dr. Park noted that each emergency department has its own culture, staffing levels, and operational constraints. The MUSC team had to customize the model for each site rather than applying a one-size-fits-all solution. The health system has so far deployed the program in the Pee Dee, Orangeburg, and Charleston markets. Plans are in place to expand to the Catawba and Upstate markets in the near future.
By starting workups early and performing tests like blood draws and X-rays while patients wait for a room, the health system reduces the time a patient spends in the emergency department. Dr. Marc Bartman reported a significant drop in door-to-provider time and overall length of stay. The changes have also improved the patient experience. The new workflow redefines the waiting area as a space for care rather than just a place to wait. MUSC introduced a Net Promoter Score survey to measure the impact, achieving a score of approximately 80. This reflects high patient satisfaction with the streamlined arrival process.
Future expansion and continued improvement
VPIT began two years ago. The integration of virtual triage nurses started in June of this year. The collaboration began when VirtuAlly intended to offer back-end services. The ED team saw an opportunity to integrate these services at the front end of the arrival workflow.
Bartman and Park analyzed the arrival workflow to identify inefficiencies. They focused on why the traditional model does not work well. The goal was to bring providers to patients as quickly as possible. The team wanted to speed up workups and reduce the time patients spend in the ED. They believe that a faster arrival process leads to quicker patient discharge.
Successful implementation requires clear communication and task ownership. Park stated that the ground team and virtual team must have separate, explicit responsibilities. This ownership prevents the need for constant prompting between staff members. Before launching, the teams hold huddles to align their strategies.
The new workflow redefines the waiting area. Park noted that it is difficult to recover from a negative experience after waiting more than 30 minutes in the lobby. This score indicates high satisfaction with the streamlined process.
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