Patients do not need to wait in emergency departments. They wait because departments cling to processes and thinking designed to produce waiting.
No More Lethal Waits explains why, and how to fix it.
I hope to put the main content into podcasts and blogs listed below. Get the newest content by subscribing to the blog (look at the right column), or check back over the next few weeks.
Intro and Step 1 – Revamp Triage
Step 2 – Close the Waiting Room
Step 3 – Redefine Nurse to Patient Ratios
Step 4 – Use Chairs and Exam Tables, Not Stretchers
Step 5 – Change Scheduling to Meet Patient Needs More Efficiently
Step 6 – Give MDs Responsibility for Flow and Hire Patient Navigators
Step 7 – Use Real-Time Data and Adopt a Full Capacity Protocol
Step 8 – Expect Resistance and Prepare for It
Step 9 – Build on Solid Leadership Principles
Step 10 – Get Political to Improve Care
NO MORE LETHAL WAITS
“A call to administrators and nursing and physician leaders alike. Be flexible and creative. Break the rules. Close the waiting room. Eliminate stretchers. Blow up triage. Increase quality. And measure wait times in minutes – not hours. Damn the torpedoes and do the right thing for patients.”
–GRANT INNES, MD, Founding Editor-in-Chief of Canadian Journal of Emergency Medicine; Head, Emergency Medicine, Foothills Medical Centre, Calgary; Professor and Chair of Emergency Medicine, University of Calgary
“…essential reading for all ED Chiefs and nurse managers who want to make the changes necessary to improve access for our sickest patients.”
–ERIC LETOVSKY, MD, Director Emergency Medicine, Department of Family Medicine, University of Toronto; Professor, Faculty of Medicine, U of T; Chief, Emergency Medicine, The Credit Valley Hospital, Mississauga, Ontario
“A great book that poses, presses, and answers the questions: How can we continue to tolerate long and dangerous waits in the emergency department when there are clear solutions which cost little and can save lives? Are we really that selfish that we must continue to have a system suited to the provider rather than the patient?”
–PETER VICCELLIO, MD, Clinical Director, Department of Emergency Medicine, Stony Brook University Hospital, New York
“…describes solutions not found anywhere else. It will transform emergency care for patients and return pride and joy back to emergency medicine. A must read.”
–MARKO DUIC, MD, Chief, Department of Emergency Medicine, Southlake Regional Health Centre, Newmarket, Ontario
“The emergency department is at the epicentre of many parts of the healthcare system. It is a complex environment interacting not only with different parts of the hospital but also with primary care, home care, and long-term care. Understanding how to get an ED functioning well is an integral part of getting the whole system to work well.”
–JOSHUA TEPPER, MD, President and CEO, Health Quality Ontario; Adjunct Scientist, Institute for Clinical Evaluative Sciences; former Assistant Deputy Minister of Health, Ontario
— Howard Ovens (@HowardOvens) February 20, 2016
“Dr. Whatley’s ideas and syntheses of ideas do more for improving the efficiency, effectiveness, safety, timeliness, and equity of urgent care than anything I have seen in writing before. The hard work is now ahead of us to convert these ideas into standard practice.”
–DARREN LARSEN, MD, Chief Medical Information Officer, OntarioMD; Vice Chair, Cancer Quality Council of Ontario
“This book has been a long time coming. Dr. Whatley demonstrates deep expertise in the effective application of fundamental industrial engineering techniques. While this is not his background and training, the results speak for themselves. Applying these concepts can be a game changer for patient flow.”
–JASON GOTO, President of AnalysisWorks, specializing in patient-flow solutions
“Where’s the beef in this book? It’s in the sacred cows of emergency medicine that Dr. Whatley kills: waiting rooms, triage, nursing ratios, and more. A must read for anyone frustrated with a system that presumes people must wait.”
–JON JOHNSEN, MD, Assistant Professor of Medicine, Northern Ontario School of Medicine, Thunder Bay
“Addresses in depth the transformation of ED processes necessary to adapt to the current climate of government cost-cutting in healthcare. Having personally experienced many of these changes, I can say that they are neither painless nor perfect for staff or patients but reflect a necessary reality.”
–STEPHEN CLUFF, MD, past Medical Director and Chief of Southlake Emergency Department, Newmarket, Ontario
“Dr. Whatley draws on successful leadership principles from business and industry, empowering conscientious ED and hospital leaders to do is what is right for all patients who come through hospitals’ ED gate. A very stimulating and awakening message.”
–STEPHEN B. STOKL, MD, Chief of Psychiatry, Southlake Regional Health Centre; Assistant Professor, Faculty of Medicine, Department of Psychiatry, University of Toronto; author of Mentally Speaking
“No More Lethal Waits reads like an ED encounter, moving from main complaint to focused analysis of signs and symptoms to diagnosis and treatment. A to-the-point read for busy leaders who know there’s a problem but have not yet seen how to fix it.
–PHIL WHATLEY, MD, Chief of Staff, Riverside Healthcare, Emo, Ontario
“There were multiple times when I laughed followed by an audible ‘ahhhhh’ in response to one of this book’s revolutionary ideas. Dr. Whatley is a true innovator and pioneer in modern medicine.”
–JASON PROFETTO, MD, Assistant Clinical Professor, Chair of Clinical Skills, Undergraduate Medical Program, McMaster University, Hamilton, Ontario
“Some problems seem intractable, only to have someone like Dr. Whatley come along and apply creativity and practicality and suddenly the impossible becomes possible. His advice can be of great benefit to any emergency department tired of the status quo and truly seeking a solution to improve its wait-time performance.”
–GARY RYAN, MBA, Chief Innovation Officer, Southlake Regional Health Centre, Newmarket, Ontario
“Candid, clear, inspiring, and practical advice on what really works for excellence in service to our patients. The result is hope. Hope in 10 steps toward a new culture of care.”
–LEE DONOHUE, MD, Family Doctor
“Refreshingly frank – a reminder that Emergency failure is really hospital failure. However, improvements to EDs will not be retained until Emergency failure endangers the financial success of hospitals’ investments. Hospitals in general must accept some risk and make changes that really work for patients, not just generate committees and more talk.”
–LES VERTESI, MD, Associate Professor, University of British Columbia; Past Head, Department of Emergency Medicine, Royal Columbia Hospital, BC; Author of Broken Promises: Why Canadian Medicare Is in Trouble
“With emergency departments desperate to find doctors, we can’t find enough spots for all the docs wanting to work in our department at Southlake. The approach described in No More Lethal Waits really works for patients and physicians. I have not seen a better way. You won’t be disappointed.”
–G. PURI, MD, Director, Nexus Flow Solutions; Deputy Chief, Emergency Department, Southlake Regional Health Centre, Newmarket, Ontario
“This book is for those of you who, like Robert Kennedy, don’t ask “Why?” things are the way they are but instead dream of things that never were and ask, ”Why not?” Dr. Whatley’s presents a perspective based on his years of experience coping with the nonsensical and harmful practices that typify many of our Emergency Departments. He provides a practical guide to transforming practices that can be utilized by the doctors, nurses and administrators leading the charge for change as well as by those on the front lines who deliver our emergency care. The lessons are an inspiration not only for Emergency Departments everywhere but also for those who every day confront their own world of ingrained hospital practices that result in inefficiency and potential harm.”
-L. Colman, MD
“The typical Emergency Department conjures images of trauma, tumult and resuscitation. Inevitably, someone counters with the picture of a waiting room packed with sick patients. And just as inevitably, someone then tells the story of the patient who died in that packed waiting room. Dr. Shawn Whatley turns this institutional norm on its head. Eschewing historical conventions, Shawn describes a patient-centered model that values efficiency and resiliency – a system where physicians and nurses are not bogged down by bureaucratic protocol, but are free to provide care in the altruistic, instinctive and innovative spirit that is everyone’s ideal…the book was highly enjoyable!”
– N. Alam, MD
“I worked with Shawn Whatley on the same leadership team that brought wait times in our ED down to the best in the province. What he talks about in his book encompasses the essential foundations of emergency department flow. This is essential reading if your department is struggling with emergency department wait times.
Before implementing the changes described in Shawn’s book – he asked our physician group whether we lowering wait times to under an hour was an attainable goal. Everyone laughed and thought the idea was crazy. Several years later after implementing changes described in Whatley’s book that vision is a reality in our department.”
– E. Chan, MD, Physician Leader, Southlake Emergency Services Program, Newmarket, ON
“The Canadian medical “system” has been in trouble for some time, in part because so many of the bromides offered to fix it become part of the problem. How refreshing to see a book that offers a different, hands-on approach, tackling systemic problems from the bottom up, so to speak, instead of the other way around. We can safely predict that this book will become a standard operating manual for Emergency departments across the country.
– W. D. Gairdner, Author, The Trouble With Canada … Still!