Reddit reviews The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department

The no wait model I am most familiar with is the "Crane and Noon" version. When you're the MD/NP/prescriber and you're taking on patients, you're at the front of the house in the "intake/assessment zone" and you're at the "assessment beds" and you're assessing and ordering. You have staff assigned to those spaces with you. When you're done, the patient goes to the back of the house. No unreasonable waits upfront. There are some hours of the day where an entire shift worth of patients for an MD come in the door. That's it, they all belong to the MD who is taking on patients. They come in while you're on "intake" then you are responsible for their assessment, treatment and disposition.

Caveats:

staffing model must match arrival curve, they rarely do and arrival curves are very predictable

team activations for trauma, STEMI, crit care, maybe even procedural sedations

each clinician group agrees as to what is appropriate care (volume and order intensity)

MDs that are used to working with a full waiting room i.e. a surplus of billable opportunities (guaranteed income) must get used to the idea of "down time" which in the current model is seen as a crisis, when there's no one to see

*some MDs see 12 pts per shift and others see 30, it is impossible to staff effectively for that level of variation, so leadership needs to be applied


[The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department] (https://www.amazon.ca/Definitive-Emergency-Department-Operational-Improvement/dp/1439808406)