What's the role(s) for LLMs in medicine?
This paper investigated GPT-4 assisting MD performance in open-ended management reasoning tasks
It found "Physicians using the LLM scored significantly higher compared to those using conventional resources"
www.nature.com/articles/s41...
I think we may have gotten to a time in healthcare unfortunately where stating “this is a patient safety threat” no longer carries weight it did to drive change given the breadth of everyday threats that exist in the system. 🤦♂️😳🤷♂️
The guidelines have been changed to favor more conservative approach to cardioversion for acute afib.
Check out CCS and CAEP guidelines.
Also I always ask the patient if they're currently experiencing palpitations when deciding on whether to cardiovert. If they say no, I assume AF >48hrs
Bringing coaches to the bedside - high performance really can't happen without a coach. Whether you're at the bedside or the boardroom, coaches and feedback are critical to success.
Thank you for the invitation @Ordinary2Xtra
podcasts.apple.com/us/podcast/d...
open.spotify.com/episode/00jV...
This is one of the best and most comprehensive sport-related concussion reviews I've come across.
Must read for those who treat/manage athletes with concussions
@nejm.org
www.nejm.org/doi/full/10....
Hospital staff injured in stabbing at QEII
Heartbreaking news out of Halifax. Hoping my fellow ED colleagues are ok.
The violence in EDs knows no limits.
Every day it happens. And will continue.
Serious interventions are needed.
www.ctvnews.ca/atlantic/nov...
Amazing work by our ED & sim team at Unity Health Toronto to demonstrate how we're improving cardiac arrest care.
Using this video we can effectively deploy training at scale.
This will save lives.
Work led by @FarahW1991 & @garrick_mok
www.youtube.com/watch?v=i6tq...
This might be my favorite article of 2024. Thank you
@bradspellberg.bsky.social for this!
The policy to override policies...basically designed to deal with when a policy makes absolutely no sense and is not in patient's best interest.
jamanetwork.com/journals/jam...
Next time you're deciding between several choices, explicitly outline the This can be applied with time, money, or even decisions in healthcare.
We use this tool at @AdvPerformHD to optimize decision making when we work with high performing teams.
Conclusion: opportunity costs are often neglected when making decisions. "bringing to mind opportunity cost can markedly affect preferences" and selected choices.
4/
Results: Simply telling people about the opportunity cost (i.e. what else they can do with the money) increased the number who bought the cheap one from 40% to 60%.
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Methods: Participants were paid $10 for work. Then had to buy either a really nice coffee mug ($10) or a simple mug ($3.99) - 50% of participants were told explicitly if they bought the cheap mug they'd have $6.01 to buy something else
academic.oup.com/jcr/article-...
2/
Opportunity cost might be the most under appreciated tactics we can use to improve our decision making. You can literally hack your own brain by explicitly framing what else you can do with an alternative choice.
This is experiment is one of my favourites
1/ 🧵
Should we integrate surprise/unexpected events in training? A study of pilots provides some interesting insights.
I now use radical transparency with simulation - providing participants with the entire case in advance but there's likely nuance to this.
pubmed.ncbi.nlm.nih.gov/29913086/
This week we launched Epic (EMR) at Unity Health Toronto. Today we crash tested it during a cardiac arrest simulation.
Most importantly, we ran this simulation as the FIRST test of a cardiac arrest patient - before this occurs in real life.
New infographic about ways to use generative AI in medical education. Some ideas we came up with:
💡generating teaching cases
🦮guiding morning report cases
📄preparing for journal club
📚summarizing large amounts of data
🔄feedback on notes/documentation
🔓 journals.lww.com/academicmedi...
High turnover of senior doctors and nurses in hospitals is associated with increased mortality for patients admitted for emergencies
TLDR:
Retention of healthcare staff is a patient safety priority & measure administrators by their ability to keep staff
www.bmj.com/content/387/...
Predicting the critical administration threshold in bleeding trauma patients.
We identified factors that predict CAT+ allowing for better understanding of who requires small vs large volume blood resuscitation
sBP <90
HR >100
RR > 20
GCS <8
#medsky
pubmed.ncbi.nlm.nih.gov/39343847/
Critical administration threshold in non traumatic critical bleeding
Important insights into non-trauma bleeding patients.
- most died due to MOF
- >50% had bleeding stop with 5 or less RBCs
- 25% only received RBCs
- mortality ~20%
pubmed.ncbi.nlm.nih.gov/39210684/
One of the best EM speakers in the world @davidcarr333
talking acute limb ischemia @EMCases summit.
As usual a world-class talk. I learn something new every time I hear him speak.
Making better decisions.
One of my favorite topics. I have the pleasure of speaking
@EMCases Summit today on decision making under pressure.
Here are the Elite 8 Decision Making Tactics that can be used across all high-stakes industries
We kicked off today's @EMCases Summit with some incredible virtual #simulations developed by @SarahFoohey using her award-winning virtual resus room.
We practiced & discussed MHP activation, resequencing trauma resuscitation & management of the head injured patient.
Sending thoughts and prayers to my US colleagues...
I didn't have on my healthcare bingo card that Dr. Oz and RFK Jr are working together to "fix" and "lead" healthcare...
There really are no 2 better people to promote grifting and anti-vax agendas disguised as science.
Wow.
Imagine a healthcare system where frontline clinicians…those actually providing care, together with patients are involved in a meaningful way in how healthcare is delivered.
How much different might our system look?
I suspect we’d have less failed “initiatives” & bureaucratic failures 🤷♂️
Recently had the pleasure of discussing all things trauma airway management on #EMCases Podcast.
Together with Dr. George Kovacs, we had the pleasure of sharing our experience and evidence-informed opinions related to trauma + airway.
emergencymedicinecases.com/trauma-airway/
Interesting study. Pause when using non-invasive BP for deciding on management decisions in hypotensive pts
Summary of findings = NIBP overestimate SBP during hypotension and underestimate SBP during hypertension
Use art lines when BP matters.
#medsky
sjtrem.biomedcentral.com/articles/10....
4 ways to mitigate this phenomenon
1. Identify the key decisions you want to undertake in advance
2. Prioritize decisions that are high stakes and make them early in the day
3. Use defaults when possible
4. Explicitly label high priority decisions and pause before delving into it.
You only have a fixed number of good decisions in a day.
This concept, aka decision fatigue is incredibly important in thinking about allocating our decision making cognitive effort. If you're involved in high-stakes decision making, failing to acknowledge this reality can be catastrophic.
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Just got this bobble head as a gift from my sim fellow. I’d say it’s legit pretty good!
Though I tend not to bring the bball to work on shift…
Happy Monday to all of my colleagues working in acute care medicine!
Our favorite day where we face no bed admits and get to see all that a dysfunctional system has to offer!
May you all manage and get thru to Tuesday!
#healthcare