Background
Emergency departments are among the most demanding clinical environments, where effective triage — quickly assessing patient severity and prioritising care — directly affects patient outcomes. To prepare emergency staff for these high-pressure decisions, the Biobizkaia Health Research Institute partnered with XR developer Virtualware to build a virtual reality solution that lets clinicians rehearse triage in a safe, repeatable environment without disrupting hospital operations.
A dedicated in-house XR capability
Rather than outsourcing development, Biobizkaia established its own standing XR team — a platform coordinator, a healthcare-focused VR developer and a 3D designer — supported by a dedicated immersive room. This in-house capability lets the institute translate clinical protocols directly into immersive training and maintain a repeatable framework it can extend to new clinical areas.
The deployment
The triage application runs on VIROO, Virtualware's enterprise XR platform, and currently offers more than 100 emergency care scenarios. Trainees work inside a virtual replica of the Emergency Department of Basurto University Hospital, assessing virtual patients, asking the right questions and making time-pressured decisions under the Manchester triage protocol. The platform automatically captures objective performance metrics — including response times and decision quality — to support structured, measurable learning, and scenarios can be repeated as often as needed without any risk to real patients.
Hardware and software
- A dedicated immersive room equipped with four HTC Vive Focus 3 headsets and ceiling-mounted tracking, supporting collaborative multi-user sessions.
- The application is also delivered on Meta Quest 3 and Pico Neo 4 headsets.
- Built in Unity and deployed through VIROO, which manages multi-user sessions and remote connections.
Collaboration and funding
The project is coordinated by Biobizkaia, with Virtualware providing the immersive technology. Clinical content was developed with nursing professionals across three Osakidetza hospitals — Basurto, Cruces and Urduliz Alfredo Espinosa — and coordinated by Sendoa Ballesteros Peña, Deputy Director of Nursing at Santa Marina Hospital and a Biobizkaia researcher. The concept originated within OSI Bilbao-Basurto as a serious game built with the Harrobia Vocational Training Center, later evolving into the full VR solution. It is funded through the MedTech programme of BIOEF (Basque Foundation for Health Innovation and Research), part of the Basque Government.
From internal tool to commercial product
The triage application has since become a commercial product available on VIROO, turning an internally developed tool into a new revenue stream for the health system. Biobizkaia frames the work as a replicable model that other hospitals can adopt, and intends to extend the same methodology to further clinical areas.
