Surge replaces Epic ASAP with an emergency department platform engineered for the highest-acuity, highest-velocity care setting in medicine. It predicts crowding before it happens, accelerates triage with AI-augmented acuity scoring, tracks every patient from door to disposition on a real-time command board, and integrates 104 Sentinel AI detection engines directly into the ED workflow — so the sepsis that would have been missed at hour three is flagged at minute twelve.
Nearly half of all emergency departments in the United States operate at or above capacity. Nine out of ten hospitals board admitted patients in the ED while they wait for inpatient beds. Approximately 500,000 ambulances are diverted each year away from the closest hospital. Patients leave without being seen because the wait is too long — each one representing a missed diagnosis, lost revenue, and a failure of the system that was supposed to catch them. ED crowding is not an inconvenience. It is associated with increased morbidity and mortality, medication errors, delayed treatment for time-sensitive conditions, and clinician burnout that drives emergency physicians out of the specialty entirely.
The emergency department is the only clinical setting where every minute of delay can mean the difference between life and death. Surge is designed for that reality — not for the orderly workflows of a scheduled clinic, but for the unpredictable, high-acuity, resource-constrained environment where clinicians make critical decisions with incomplete information under relentless time pressure.
Conventional triage assigns an ESI level based on a brief nurse assessment — chief complaint, vital signs, and a subjective acuity judgment made in under two minutes. Surge augments this process with an AI layer that analyzes the patient's complete longitudinal record in real time during triage. It identifies risk factors invisible to a spot assessment: the patient triaged as ESI-4 for “abdominal pain” who has three prior ED visits for the same complaint in six months and a family history of pancreatic cancer. The patient presenting with “dizziness” whose last echocardiogram showed an EF of 25%. The elderly patient with “weakness” whose home medications include warfarin and whose last INR was 4.2. Surge surfaces these signals to the triage nurse as contextual risk indicators — not as blocking alerts, but as clinical intelligence that informs the acuity decision.
The track board is the nerve center of every emergency department. In Epic ASAP, it is a status display — a list of rooms, names, and color-coded acuity levels mounted on a wall monitor. In Surge, the track board is a real-time command surface. Every patient is represented by a dynamic card showing their current ESI level, time since arrival, active orders with pending/resulted status, Sentinel AI risk scores, assigned provider, and disposition probability. Cards change color as patients exceed time thresholds. Bed turnover predictions show when the next room will be available. Provider workload is visualized so charge nurses can balance assignments without manual counting. The entire ED — waiting room, treatment bays, fast track, resuscitation rooms, behavioral health holds, and boarding patients — is visible in one view.
Emergency physicians cannot stop to type. They move from patient to patient, performing assessments, ordering tests, interpreting results, and making disposition decisions in a continuous flow that does not accommodate a desktop charting session. Surge extends Clarion Scribe's ambient documentation engine with ED-specific capabilities: the physician speaks their assessment while examining the patient, and Surge generates a structured ED provider note with chief complaint, HPI, physical exam, medical decision-making, and a real-time ED course that auto-populates as orders result and vitals trend. The “ED Course” — the chronological narrative of everything that happened during the visit — builds itself automatically from timestamped clinical events rather than requiring manual entry after the fact.
When a trauma activation is called, every second of coordination matters. Surge provides structured activation workflows for trauma (Level I and II), stroke, STEMI, sepsis, and cardiac arrest. A single activation action triggers simultaneous notifications to the required team members based on the activation type, auto-assigns roles on the resuscitation team, opens a time-stamped resuscitation log, pre-selects the appropriate order sets, and reserves the designated resuscitation bay. EMS pre-arrival data — mechanism of injury, vitals in the field, estimated arrival time — flows directly into the patient's record before the ambulance reaches the bay, giving the team critical preparation time. Post-event, the system generates a structured debriefing summary with all timestamps, interventions, and outcomes for quality review.
ED crowding is predictable. Volume patterns follow seasonal trends, day-of-week cycles, local event calendars, weather patterns, and epidemiological signals. Surge's crowding prediction engine forecasts ED volume, acuity mix, and boarding pressure 6 and 24 hours in advance with 87% accuracy. When the model predicts that the ED will exceed capacity at 2:00 PM, the system triggers a graduated Full Capacity Protocol at 10:00 AM — proactively initiating surge staffing requests, activating hallway treatment spaces, accelerating discharge rounds for boardable inpatients, and diverting low-acuity arrivals to fast track or virtual triage before the waiting room fills.
The bottleneck in every crowded ED is not the front door — it is the back door. Patients who need admission wait hours for inpatient beds while occupying ED treatment spaces that could serve new arrivals. Surge attacks this bottleneck from both directions. On the ED side, disposition prediction identifies patients likely to require admission within 30 minutes of arrival using clinical indicators, lab trends, and imaging results — enabling early bed requests before the formal admission decision. On the inpatient side, Surge integrates with Clarion Tempo to identify beds that will become available based on predicted discharge times, not just current census. The system matches pending admissions to predicted bed availability, reducing the gap between “decision to admit” and “patient leaves the ED” by an average of 98 minutes.
The ED-to-inpatient handoff is one of the most error-prone transitions in medicine. Critical information is lost between the ED physician's assessment and the admitting team's evaluation. Medications ordered in the ED are not carried forward. Pending lab results arrive after the patient has left the ED but before the inpatient team has assumed care. Surge eliminates these gaps through a structured transition workflow: an AI-generated handoff summary synthesizes the ED course, active orders, pending results, administered medications, and clinical trajectory into a concise document that the admitting provider receives before the patient arrives on the floor. Pending results are tracked with automated routing to both the ED physician who ordered them and the inpatient team who will act on them.
CMS tracks five ED crowding-related quality measures under the Hospital Inpatient Quality Reporting Program. Joint Commission mandates boarding time limits. State regulators monitor LWBS rates, diversion hours, and door-to-provider times. Surge captures every required data element automatically from timestamped clinical events — no manual abstraction, no retrospective chart review. Real-time operational dashboards show door-to-doc time, door-to-disposition time, LWBS rate, boarding hours, and patients-per-provider across the current shift with trend comparison against prior weeks. Leadership receives daily executive summaries; quality teams receive automated CMS measure reports.
A Level I trauma center with 85,000 annual ED visits replaced Epic ASAP with Clarion Surge. The predictive crowding engine reduced ambulance diversion hours by 61% in the first six months by triggering proactive surge protocols an average of four hours before the ED would have reached capacity. The AI-augmented triage system identified 247 patients in the first year who were initially triaged as low-acuity but whose longitudinal records revealed high-risk features — 14 of whom were subsequently diagnosed with acute conditions requiring immediate intervention. The LWBS rate dropped from 5.8% to 3.4%, recovering an estimated $2.1 million in annual lost revenue.
A 320-bed community hospital with a 28-bed ED deployed Surge to address its most critical operational challenge: ED boarding. Admitted patients were occupying ED beds for an average of 4.2 hours while waiting for inpatient rooms. Surge's disposition prediction engine began requesting beds within 30 minutes of patient arrival for 84% of patients who ultimately required admission — cutting the average boarding time to 2.6 hours. The ambient documentation engine eliminated after-shift charting entirely, recovering an average of 47 minutes per physician per shift. Three emergency physicians who had submitted intent-to-leave notifications citing burnout withdrew them within 90 days of Surge deployment.
I have worked in emergency medicine for eighteen years. For the last decade, I have watched the ED become a holding ward for admitted patients that the hospital has no beds for. Surge did not solve the inpatient bed crisis — no software can. But it gave us something we never had: the ability to see the crisis coming four hours before it arrived and act before the waiting room filled. We went from reactive to predictive. That changed everything.
A 67-year-old woman presented with dizziness. She was triaged as ESI-4 — low acuity, long wait. Surge flagged her record: EF of 25% on a recent echo, potassium of 5.6 three weeks ago, currently on digoxin and spironolactone. The triage nurse upgraded her to ESI-2. Her potassium was 6.8. She was in pre-arrest hyperkalemia. In any other system, she would have waited two hours in the waiting room. I do not know what would have happened. I know what did not happen, and that is enough.
See Surge configured for your ED volume, your trauma level, and your operational challenges.