Mayo Clinic Health System-Eau Claire

Eau Claire, Wisconsin

Using shared governance and staff nurse leadership, the ED at Mayo Clinic – Eau Claire addressed delays in triage start times through a nurse-led quality improvement initiative. Front-line nurses identified workflow inefficiencies through direct observation and collaborated with multidisciplinary stakeholders to implement a streamlined triage process. Key changes included clarifying roles, improving communication, optimizing workflow, enhancing supply and technology use and providing targeted education. Average time from arrival to triage start decreased from 24 minutes to 12.4 minutes, while triage accuracy improved from 95 percent to 97 percent. These sustained improvements enhanced patient safety, experience and operational efficiency despite increasing patient volumes in the 51-bed ED.

The team uses a multi-layered approach to reduce patients leaving before completing care, including those who leave without being seen, elope, leave against medical advice or are in police custody. Strategies include rapid intake and early medical screening, expanded inpatient capacity, improved patient flow, risk screening for elopement, enhanced monitoring, clear communication and shared decision-making. Patients in custody receive secure, closely coordinated care with law enforcement. Performance is monitored through LWBS, elopement and AMA rates; patient feedback; and ED throughput measures such as arrival-to-screening time and length of stay.