Emergency department (ED) wait times continue to be a pressing health issue in Canada. A search of the Canadian Business & Current Affairs database using four combinations of ED/ER and wait, both spelled out and abbreviated, yielded 321 articles in 2015. To put that into perspective, a search for pharmacare and related terms, a re-emerging hot topic in 2015, yielded only 107 articles.
No More Lethal Waits is a highly readable and compelling book about the experience and lessons learned from the transformation of the ED at Southlake Regional Health Centre during author Shawn Whatley’s tenure as interim medical director of emergency services and physician leader of the Emergency Services Program in 2008–2014. Southlake is a full-service hospital located in Newmarket, Ontario; it has almost 400 beds, handles more than 100 000 ED visits annually, and serves more than a million people.
Unlike many studies of wait-time journeys, this one does not require postgraduate training in operations research or queueing theory to appreciate it, and Dr. Whatley uses several vivid analogies to draw key lessons. The book chronicles Southlake’s 10-step journey that resulted in a fundamental revamping of its ED. Top
The 10 steps borrow heavily from and build on the experience of Toronto’s St. Joseph’s Health Centre, which transformed its ED under the direction of Dr. Marko Duic, who was recruited subsequently to Southlake as chair of Emergency Medicine. Some of the steps, such as 2, “Close the waiting room,” and 4, “Use chairs and exam tables, not stretchers,” will no doubt seem heretical to some!
Aside from a methodical and thorough exposition of the 10 steps, Dr. Whatley pays great attention to the motivations, thought processes, and attitudes of the physicians and nurses in the ED, and the same elements are probably applicable in some measure to many other health care settings. Moreover, the treatment of nurses, physicians, other professionals, and staff seems even-handed. The book is as much a case study of change management in general as it is a guide to transforming the ED specifically. Throughout the book there was also emphasis on the importance of the patient. Top
By the time I had finished reading this book, my curiosity was piqued as to how Southlake is doing now, so I went to the Canadian Institute for Health Information’s yourhealthsystem.cihi.ca to see the most recently posted results (time reference is not specified). They are impressive. The 90th percentile for ED wait time to initial physician assessment at Southlake is posted as 1.4 hours, compared with 3.2 hours at comparator large community hospitals, 2.5 hours for the Central Local Health Integration Network, 3.0 hours for Ontario, and 3.1 hours for Canada; in other words, about half the wait at these benchmark comparators.
In summary, No More Lethal Waits deserves to be widely read — not just in the ED community, but also by any health service where waiting is an issue. No More Lethal Waits is available at amazon.ca as well as barnesandnoble.com.
Owen Adams, PhD, is chief policy advisor at the Canadian Medical Association, Ottawa.
Correspondence to: email@example.com