I think performance rather than accountability occurs in the NHS particularly when there is a lack of cultural safety. Fear of professional consequences can lead to the performance of a report being seen as an action complete and personal risk abated, avoiding the difficult questions
I think Eliot's description of the dysfunction of democratic institutions can apply to the NHS too. Even worse when those within an organisation see the performance as the aim, rather than seeking the outcome of meaningful patient safety actions, in whatever guise that may take.
The events of the last 24 hours show why it's important to build functional verification structures in public and counterpublic spaces to resist the authoritarian erosion of our democratic systems, as described in this thread.
I agree that front loading senior decision making has benefits throughout the system. In our Trust at least, that requires significant expansion of those senior staff numbers. Consultant's can't be at the front decision making when their bandwidth is taken up fire fighting patient safety/crowding
The US truly is a foreign world
Recognition of ordinary dying is a core emergency medicine skill that allows patients and their family dignity and to prioritise what is important for them
No family *wants* their relative to die, but it is our job to counsel and support them, not offer false hope
@robjimfleming.bsky.social was there
Quiet as in "not newsworthy", but far from quiet in our Emergency Depts.
Not newsworthy as it is just the predictable pressures on acute care of a four day festive w/e with an ageing & multi morbid population who try to hold out over Xmas & whose limited community safety nets are still in twixtmas
On a white rectangle green text at the centre says: "Emergency departments are full of elderly, frail, confused, high-acuity patients. To say they must never be in corridors is to fundamentally misunderstand the pressure profile of modern emergency care.". In the bottom right hand corner is a small green logo that says: Patient Safety Learning.
In a new blog on corridor care, Claire Cox argues that to have a significant impact, guidance needs to move beyond what 'should' happen.
▶️ www.pslhub.org/learn/improv... #patientsafety
Two scatterplots side by side. The chart on the left shows the relationship - or - rather - the lack thereof - between the number of A&E attendances per day and each day's four-hour compliance. The chart on the right shows the (quite strong) relationship between the level of crowding in the A&E each day and each day's four-hour compliance.
It was good to see @samfr.bsky.social say today that "the main reason for lengthy A&E waiting times is the lack of hospital beds for people who need admitting, which gums up the whole system as they have to keep being treated by emergency staff."
samf.substack.com/p/optimism-o...
#rstats #ggplot2
And I also worry about the misapplication of AI in EM - computer says diagnosis is/isn't xyz. AI/LLM could have useful roles in EM, but as a decision aid in diagnosing AI is open to the same input/output traps as current decision aids
As departments are under increasing pressures to stream undifferentiated patients from triage, I worry that patients may lose out on seeing a specialist generalist, and are put too early into rigid boxes of medical/surgical, or PE rule-out path/low risk abdo pain etc.
I've found PE on CTPA when low Well's/negative D-dimer, ICH in people not meeting NICE HI criteria, and significant cardiac disease in the under 30s. All of these required thinking beyond the decision aid
Musing today that decision aids in EM can lead the unwary (more junior colleagues especially) into quite rigid and narrow assessments/thought processes, when people are a lot more varied and complex and nuanced. And then how as seniors can we mitigate this and educate in the busy modern ED 🤔
Until and unless we have a political class willing and able to state these basic truths about social care, reform its provision so it doesn’t carry on destroying local govt, and actually raise the taxes needed to fund it properly, we are, not to put to fine a point on it, f***ed on this issue.
Make it make sense...🤦
*Screams* in Emergency Medicine
Close up of a red tulip flower in a garden bed, with a daffodil out of focus in the background
I'm particularly enjoying the tulips and daffodils this year. They seem especially abundant and vivid.
I can't decide if that is because the weather conditions have been just right for a particularly good crop this year, or I'm noticing them more as I missed the season last year
A photo of Pope Francis with the quote: “We must meet one another doing good. ‘But I don’t believe, Father, I am an atheist!’ But do good: We will meet one another there.”
One of my favourite quotes from Pope Francis, who said he would be a “Pope of the poor”.
He spoke out against injustice, emphasizing the need for compassion, calling for peace & strongly supporting the Palestinian people under attack. Rest in peace.
And, I think residents are much more likely to pick up the phone for advice if they know the consultant hasn't been on shift since 8am +/- got a clinic/another 24hr on call the next day. I certainly became more willing to "disturb the boss" when the EM on call changed from 24hr to 1700 start.
I can't recall who proposed, as way of analogy, the use of formal consent quantifying the risks of hospital admission in older people.
But I really wish I had figures at the tip of my tongue to help challenge the notion that admission is "safer" when relatives are refusing to allow discharge
I enjoyed this episode. You don't know the talent you are missing unless you allow it in. And sometimes (often) that needs people to actively invite those not previously considered. Diversity. Equity. Inclusion. Good things.
Whilst I'm very glad journalists continue to expose more details of this particular war crime, I remain flabbergasted that Israel is able to continue to flagrantly ignore international law daily without consequence
A light blue diagram depicting the sea, with the water's surface at the top, and just below it is an outline of the Mary Rose, with the depth (12m, 40ft or 6.7 fathoms). There is a line showing the seabed, which takes a rapid dive into the vertical...
On the anniversary of the sinking of the Titanic, we thought we'd answer a question that's often asked,
"If they raised the Mary Rose, why not raise the Titanic?"
Allow our scaled diagram to explain...
An extremely stocky and muscular ox, painted by George Garrard in 1813.
"they hate our beef because our beef is beautiful and theirs is weak"
our beef:
I love learning new things! I did not know this.
Another complication to add to the list of why *measles is a bad thing*
🧵 I want to follow up this earlier thread by examining why the USA finds itself in the state it does at the moment; the process of disordered discourse capturing state institutions and how it inevitably results in a slide towards authoritarianism, a process we're seeing unfold before our very eyes.
We can upload 3 minute videos now.
YOU KNOW THE RULE
HE'S LITERALLY READING A SALES PITCH
Happy International Women’s Day.
I’m fortunate to have brilliant women in my life as friends and colleagues along with male allies prepared to stand up and be counted.
Keep on keeping on.
#IWD2025 #wingwomen
Important point. I am extremely pro-defibrillators and CPR. When you have a primary CARDIAC problem causing cardiac arrest, with a rhythm that can be shocked, quick defib gives an excellent outcome, even in older or more clinically frail patients 1/2
Once upon a time, some villagers came across a large, ornate wooden box in the local woods. On the side of the box was a message:
“Whatever money you put in this box will, in future, grow to become 2.5 times larger.”
1/
