Andie Haynes
@EMTDocAndie
Followers
451
Following
236
Media
24
Statuses
2,752
EM / ICM mix with a small dose of event medicine. A good side serving of Ergonomics and Humans Factors. Sailor. I like to climb snowy mountains. 🏳️🌈 🏳️⚧️
Hamilton, New Zealand
Joined March 2014
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
#WWEBadBlood
• 331182 Tweets
The Rock
• 295866 Tweets
Michigan
• 159054 Tweets
#precure
• 111947 Tweets
Vandy
• 102695 Tweets
#ブンブンジャー
• 76785 Tweets
Roman
• 74605 Tweets
Yankees
• 73422 Tweets
Dodgers
• 69583 Tweets
Vanderbilt
• 69313 Tweets
Dark MAGA
• 62374 Tweets
Bama
• 61645 Tweets
トッキュウジャー
• 59171 Tweets
Ohtani
• 52623 Tweets
Shohei
• 52184 Tweets
Watch Sant RampalJi YouTube
• 51285 Tweets
#仮面ライダーガヴ
• 49637 Tweets
#UFC307
• 47881 Tweets
ドジャース
• 44128 Tweets
プリキュア
• 41539 Tweets
Rhea
• 39776 Tweets
Royals
• 27155 Tweets
Goldberg
• 26646 Tweets
ワンダフル
• 25787 Tweets
Gago
• 25734 Tweets
ポストシーズン
• 23867 Tweets
Raquel
• 23111 Tweets
Ashton Jeanty
• 18476 Tweets
Gunther
• 18102 Tweets
いろはちゃん
• 16735 Tweets
ニチアサ
• 14145 Tweets
同点3ラン
• 13470 Tweets
大谷さん
• 11217 Tweets
Yamamoto
• 10260 Tweets
@MedicGrandpa
That's totally bonkers. Military dress uniform skirts are almost exactly that length and have been for many many years. I'd suggest if it was long enough for the bastion of conservatism that was RMA Sandhurst in 1990 it's long enough for an OSCE!
0
2
117
Sorry to call out a particular training video, but this is the sort of thing that can easily become negative training. If that was real smoke you shouldn't be there. The lesson here should be about controlling the environment and moving the patient to an appropriate place of care
12
5
102
@Cray_tweets1
2/2 This is one big reason doctors (appropriately IMHO) get really angry about this. ACPs just starting working are generally paid more for less hours (40 vs 56/wk) than registrars on the same tier. They also aren't forced to move hospital every 6-12 months.
5
7
54
@DrRanj
@gmcuk
@stonewalluk
@LGBTfdn
@VirtualNHSPride
@RainbowNHSBadge
@KeshetUK
Having looked through his timeline I'm fairly amazed he has so far avoided a
@gmcuk
referral. There's enough COVID miss information there to discuss for weeks, before you get to some of the worse stuff like the image you've got a screenshot of.
6
2
53
@DrEilidhMaria
It took me 15 years to realise/acknowledge. Everyone kept saying the same things to me as well - "it'll be fine when you are...". It never got fine, it just got more frustrating. Working for a charity and in the private sector finally made me realise the NHS just wasn't for me.
0
1
25
Some fairly high profile pre-hospital training courses need to read this and understand the evidence behind the recommendation to avoid using extraneous or unrealistic cognitive loading ploys and tricks....
How should we design and deliver simulations for emergency teams wanting to improve performance under pressure?
#hcsim
#FOAMed
@purdy_eve
@WarwickIsaacson
@AEM_ETOnline
1/4
2
79
142
3
6
25
Absolutely agree. The data presented is flat out false for a UK trained ENP/ACP. If you want to debate then use real data. Anecdotally in my local ED if I want to hand over a sick patient I make straight for the nearest ACP who's likely got x2 the experience of most of the Drs.
Thank you to all of my doctor colleagues highlighting such nonsense, I (we) really appreciate it and you.
In the US it is possible to do nurse training and jump straight on to an ANP masters, but not in the UK, this account is quite frankly untrue and a patient safety risk.
1
1
31
4
2
22
Anyone want to come and work on a new and evolving community emergency medicine platform? Full time, part time, and bank are all available.
We're recruiting for a number of roles for our Physician Response Unit.
Visit and search 'PRU' to view the range of jobs available.
1
22
38
4
12
23
@twigthewonder
@MaxineWade
I don't want to sound rude, but the NHS is losing nurses at a totally unprecedented rate. The intensive care I work in has lost nearly 40% of it's nurses in the last 3 years, and we are not the worst affected in the area. People ARE leaving in massive numbers.
0
2
21
@emergencymedSpR
We have a tick box as well, and it explicitly tells you that you don't need to do the free text notes as well. I just do an appropriate text entry anyway, seems to be much more dignified and if I was family I'd certainly prefer it.
0
0
19
@silv24
I think in general the difference is that outside of medicine it's a few individuals who might treat others in a patronising fashion. In medicine the whole system is set up specifically to encourage people in their 40s with 15+ years experience to still be treated like children.
1
1
17
@DrKateLovett
@adamwesterink
@LeylsTurk
I periodically photograph extra special ones to (anonymously) use in Human Factors education. My current favourite is the poster that says "we put up a poster about this 6 months ago, and it didn't work, so now we've put up a new poster that is in ALL CAPS and red text"
0
0
15
@medic_m_a_c
@CCWearmouth
I've only interacted with GP comupte systems in 2 jobs, but both systems would fairly easily let you remove a diagnosis and code it as "entered in error" or similar. The other (more formal) recourse is to remind them that under GDPR they are required to have accurate information.
0
1
14
@silv24
Having worked in several industries before medicine I can certainly say that the way we get treated is far far far worse than any other industry I've worked in (military, accounting, commercial watersports, retail).
1
1
11
@danleisman
Seldinger A-lines require you to directly touch parts that will be intra-vascular (line, wire), and are therefore done sterile. PIV is aseptic non-touch, so doesn't need to be. If you are using a cannula style A-line with no wire then ANTT is fine.
0
0
12
@docib
@geri_baby
@UCATofficial
I had to do this multiple times as an Ortho FY1. Always seemed appropriate to me and the bosses...
0
0
11
@mmbangor
@andyvole
@Andywebster
@docib
@DanBoden1
Key skill of doing ED majors efficiently but effectively is knowing when to abandon the traditional ED focussed type consultation and work like a geriatrician for 30 mins so you gather enough info, but also know when even that won't work and you really can't avoid admission.
0
8
11
@ashleighlowther
@drunacoales
The ACPs in ED at
@nottmhospitals
are some of the best EM practitioners I've worked with, and are amazing at helping the juniors (and me!).
0
4
11
A really consider summary form
@StevenShorrock
that helps explain some of the things you see written about organisational "culture", and why sometimes it seems hard to make it fit on the shop floor.
“Safety culture” and “just culture” are not cultures or even subcultures. They are tropes to describe a spotlight or focus on a particular value within a culture. Hence they provide reason to ask questions, often a means to access people, and have a conversation.
5
17
51
0
2
9
Still time to get an application in if you'd like to come and work on a new Community Emergency Medicine team in Lincolnshire.
#CEM
We're recruiting for a number of roles for our Physician Response Unit.
Visit and search 'PRU' to view the range of jobs available.
0
4
9
0
5
10
If you practice in EM/PHEM/ICM you need to read this, and probably follow
@LondonAllergy
for all your allergy-related FOAMed needs...
1
1
10
@jamieswilson
@StevenShorrock
@jw_bagpuss
@keatingteam1
@TimAustin87
@sbattrawden
@DrUmeshPrabhu
@patientsafe3
@DrMurphy11
@SLBaldry
@bochealthcare
@hSafetyIB
@ptsafetyNHS
@boconline
@MHRAdevices
@ACSQHC
@HEFTPST
@YH_PSTRC
@Imperial_PSTRC
@K_G_Spearpoint
@mmbangor
@nhsconfed
@NHSImprovement
@sarahwollaston
It shouldn't be left up to training to try to mitigate this kind of risk. Training interventions only makes the humans in your system more reliable, not 100% reliable. If you can design out a possible error it will always work. Training is often the least effective intervention.
1
5
10
Feel the need to retweet this, firstly for practical awareness in case anyone overhears someone giving such inaccurate "advice", and second just to remind everyone just how much equality work remains to be done in healthcare....
It’s 2023 and I hear today that people are still telling female trainees they can’t do PHEM if they have (or plan to have) children. I can provide evidence that it’s simply not true. If you hear someone saying this shit, please call them out.
15
48
265
0
2
9
For anyone still wondering why we need DEDICATED E&HF professionals in healthcare, in addition clinicians who part-time (which includes me) or have an interest, read....
🔓Implementing human factors in anaesthesia.
"...we lament the insufficient representation of HF professionals involved in the coproduction of these guidelines and the absence of any reference to professionally qualified HF expertise."
🔗
1
10
31
1
1
9
Need to have this as the first thing in every HF training course.
Human Factors ≠ Training
Human Factors ≠ Teamwork
Human Factors ≠ TRM
Human Factors = Work Design
4
42
66
1
4
9
Totally - there are a few interventions that my PHEM team can deliver that my tertiary ED team can't, and another (bigger) set that are quicker/easier/more consistent in the PHEM team because of better SOPs, cognitive aids or equipment.
It is often said that pre-hospital critical care teams bring the hospital to the patient.
Yesterday I found myself preparing for anaesthesia in an unfamiliar in-hospital location.
Used our pre-hospital pre-anaesthesia check list.
Worked like a dream
The tide has turned 😃
1
12
88
1
1
8
Technically yes, but modern ECG software does a huge amount of post-processing. Some of this may (will) include assumptions the programmer has made about lead placement. If you do serial 12-leads on a patient and move the ground lead you may see clinically relevant differences.
“You can put the black ground lead of the ECG anywhere on the body”
-
@PhilDrummer64
ECG Guru
3
7
16
1
3
8
@DrJonBailey
Less protocols? Are you mad? This is UK emergency medicine where the guideline (which will immediately be called a protocol regardless of the title) is absolute king!
In other news I'm averaging one bowel obstruction per month I get handed over as "sepsis ?source"...
1
1
8
@critconcepts
In the UK - because the national guideline sort of tells them to, and guidelines in the UK are often treated like they are instructions on stone tablets.
0
0
8
@MattHancock
Hopefully this is a joke... Where is the data coming from? Every ED (that's what we've been calling A&E since about 2002) I've worked in can't accurately predict wait times because the workload is constantly changing. How is the magic app going to manage it?
1
0
8
All the guideline writers in the NHS need to read this, and understand the consequences. Trying to have a guideline for everything, and making sure everyone follows them, all of the time, will not stop harm, errors, or make you magically much safer.
Kathy Abbott (Chief Scientific and Technical Advisor, FAA) on work as never imagined in the context of equipment and procedure design.
#SafetyForum
0
6
11
2
4
7
@LeechCaroline
Have carried both iSTAT and EPOC pre-hospital. Since 2015 I can think of only 1 big-sick patient where it genuinely changed my management (exertional heat stroke). If you do get a device EPOC is massively more suited to the PHEM environment than iSTAT.
0
0
7
@fluidloading
@EMManchester
@Obidoc
@dasairway
@MartinBromiley
@cliffreid
@simonjudemercer
That's not really the point of a checklist. It isn't to improve the mean performance, it's to prevent the very occasional critical error. You won't measures it's benefit in that kind of study unless the system is massively unsafe to begin with.
1
2
7
@PulmCrit
@iBookCC
From observation I'd suggest 4mg is way too small a dose to be beneficial. Everywhere I've worked uses 10mg, and any time I've tried a smaller dose it has had no effect. Equally do we really think single drug interventions are likely to work? We need to look at grouped therapies.
2
0
6
@Tom_the_Knowles
@caej90
Sure. No problem. Loads of jobs that aren't open to doctors but are to paramedics. (The SECAMB CCP job is basically my ideal job). Also internationally transferable much more easily than a medical degree to certain destinations.
0
0
5
@coffeeheadaches
@davehartin
What a lot would like: ED delivered crit care rather than get yanked to go back to majors leaving ITU on their own with patient after 10mins
3
1
7
@andyvole
@mmbangor
@Andywebster
@docib
@DanBoden1
The 60 and 20 minutes we've always thought of is still possible for about 80% of patients in my opinion, but the very complex and frail are becoming more common, so the other 20% (ish) take much much longer, especially if you're trying not to admit them.
2
2
6
@DocsDoItBetter
@CatrionaRennis1
@jcollm1
@OrthopodReg
@NHSBartsHealth
Pretty sure every locker room for clinical staff is the same. Never had a locker in a hospital job (had one as a med student, and as a tech in the ambulance service). One trust in work in has a registrar's desk in the ITU office, which is as close as I've come to having a space.
1
1
6
@AlanJCard
Because simple concepts like that are taught at undergraduate level in engineeri g, process design, HF, etc but are never even mentioned to healthcare students or new clinical staff.
0
2
6
@ogi_gajic
@DogICUma
This. 90 day mortality is such a blunt instrument, and patients and clinicians should (and do) care about lots of other things beyond dead Vs alive.
0
0
6
@Stam_EM
@DrKanaris
@DrLindaDykes
If you followed the evidence and not the guidelines you would use Hartman's in DKA. In the full text of the current UK guidelines it says that critical care areas may prefer to use Hartman's, and the recommendation of saline is due to physician familiarity with it.
2
0
6
@hakking
@EMTAcommittee
@RCollEM
Try looking at combat aviation instead - unpredictable, non-elective, someone actively trying to kill you... A better place to compare EM to, but interestingly still use a lot of the same system level solutions at commercial aviation and other high performance industries.
0
1
6
A succinct reminder that following policies might be increasing safety... Or... People deliberately NOT following policies might be increasing safety.
"Safety is constantly being created by those working at the sharp end—sometimes because of the rest of the system, sometimes in spite of it." --
@ri_cook
0
3
7
1
1
6
@CareSwasft
Inappropriate c-spine paranoia at the expense of other things. Inadequate analgesia (including the belief that IV paracetamol is ok for big injuries). Excessive time on scene after being in the ambulance doing pointless stuff like 12-leads.
1
0
6
Just had absolutely INCREDIBLE customer service from
@sardjv
and specifically Megan Holmes via their online customer support tool. So nice for a company to be responsive, polite and efficient all at the same time and with a smile.
2
2
6
@sarah_aslannnn
In the UK system it absolutely is. However in another system then it may well be that the doctor is never the "emergency IV access practitioner", and thus that skillset isn't required. Different systems are often more different and diverse than you imagine.
1
0
6
@cliffreid
Personally in the UK at present I'd try to give the whole resus area to ITU clinicians and not have any ED medical involvement at all. Use a mixed nursing staff ITU/ED. Not sure that's a politically ok answer, nor acceptable to ITU, nor applicable to where you work
@cliffreid
...
14
0
6
@DrJonBailey
@dremmayoung
@EMTAcommittee
Unfortunately having had 1 bad feedback on an MSF a few years ago that created about 20 meetings, a few reviews and me nearly quitting medicine I'm now highly selective about who I give them to!
3
0
6
@HectorDubois4
@ETMCourse
@PhilipUK3
This is absolutely correct. There is reasonable evidence that trying to test pelvis stability has VERY low sensitivity. Most pelvic surgeons will tell you they think it can cause harm (although no evidence here). In the UK we teach people to NEVER do this.
1
0
6
@TessaRDavis
@LGeddesEM
@DrJamieFryer
The "we" is surely those in a position to instigate system-level cultural change. No group at anything below trust-board level are going to be able to do this. Making it the responsibility of any particular group of people is as bad as blaming the trainees for being burnt out.
0
0
5
@sarah_aslannnn
I've never found anyone who knows. One WD I worked in swapped entirely to using FP10s instead of hospital scripts and the sudden reduction in delayed discharge was incredible!
0
0
5
@sarah_aslannnn
In some places PIV access is so commonly done by non-physicians that it just isn't part of their skill set. Similar to (for example) wound dressings in the UK being something few doctors do regularly. It's not about basic Vs advanced, but more about how the system is set up.
1
2
5
@rachelgemma90
No guidelines I'm aware of, but if you want a detailed chat I can definitely walk you through what needs to be in a guideline. I've never seen anything pre-made that's even close to accurate unfortunately.
1
1
5
@punkrockPICUdoc
@MBNYPharmD
@PulmCrit
@reverendofdoubt
@CritCareMed
This is a good explanation of the dosing ranges. It's certainly not a discrete threshold between dissociated and not dissociated (although in small humans with low VD sometimes it looks a bit like that!).
0
0
5
@simontutt88
@Megsenmumdr
@Alison6123
Yep. It doesn't help the overall workforce development when people take a good idea and start cutting corners in an unsafe fashion.
0
1
5
Agree so much with this. Told recently that I should have followed a protocol even though it's wasn't optimum, or what was later recommended by the specialist team...
Protocols set the lowest standards, not the highest. I have seen protocols used inappropriately, disregarding common sense, to the detriment of patients and health care costs.
Protocols are like scalpels. You can still use it incorrectly.
14
58
151
1
1
5
@CodeNeil
@DrAdamCol
@cevers21
Been doing exactly the same for 15 years of pre-hospital work, and was taught that approach in central London where we saw a lot of ODs. Waking people up generally means you've given enough to give them acute withdrawal Sx, which is both dangerous, and very unpleasant for them.
0
0
5
@Megsenmumdr
In theory, but then so can doctors of various grades including those with no speciality training in any area. What ACPs should not be able to do, if employers are doing it right, is work at registrar grade or equivalent in a speciality that have not been trained and assessed in.
1
0
4
@rowan_wallace
@mmbangor
Also scary how far you can make it through ED before anyone asks or finds out if you CAN walk...
0
1
5
I often think this is a problem in the massive "teams" we have in healthcare. Similar logic and limits apply to the maximum number of people or sub-units a single manager or leader can usefully be responsible for.
"Dunbar's number" says people can only maintain stable relationships with 150 others max: human structures at a scale beyond 150 will often fail to work. Do we need to rethink rules/norms for managing large scale organisations? V
@LVElegem
@sketchplanator
8
42
159
1
4
4
@HumanFact0rz
@mina_el_naguib
@karimbrohi
@TJCoats
@LeechCaroline
@canibagthat
@davepaskarMD
Fully alert with that BP is going to be a tricky anaesthetic. I'd argue that giving (for example) 1 PRBC and 1 FFP reasonably slowly while waiting for theatre is better for coagulation and haemodynamics than bolusing them after the BP has tanked on induction.
0
0
5
"
@CritCareReviews
: saline? all doom and gloom?
http://t.co/VfoYFN14Gz"
- pretty good round up of things to consider when picking you fluid.
1
5
5
@reverendofdoubt
@PulmCrit
@MdSpuds
My local ED has a weird affinity for IV digoxin... If they are hypotensive (even a little) on arrival then you'd have to work hard to talk me out of amiodarone as first line (assuming not hypotensive enough to warrant immediate DCCV).
2
0
5
Brilliantly written, and such an important message for anyone in EM, acute med, ICU or GP.
0
1
5
@Andywebster
@marktaylor18
@andyvole
@mmbangor
@docib
@DanBoden1
@dock2222
All true, but a frailty assessment to make an effective discharge plan is more than a clerking, and often focussed on slightly different aspects of the history. More functional and less medical.
1
1
5
This might be the most absolutely wild piece of quantitative psychology data I've ever seen. The study hits its own measurement limit, the actual number is HIGHER they just didn't allow for that. (because who would assume a 1000:1 civ:combatant casualty ratio was acceptable!)
This study found a specific value: “On average, participants indicated that they would be willing to kill 575 Palestinian civilians in order to save the life of one Israeli soldier wounded by a Palestinian militant”
8
691
1K
0
3
5
@Cray_tweets1
6/x So overall I think it would be great if we could stop arguing about what label people wear (doctor/nurse/paramedic/etc) and discuss the SKILLS required to perform a specific function within the health service, and how to get them.
3
0
4
@WasteClinical
@jaydbint
@mevparekh
I have once witnessed this happen to a consultant when the confused reader was a detective chief inspector... Results were less than pretty, but quite amusing for the rest of us who had been struggling for ages with the legibility of said person's notes.
0
0
5
@MisterHreben
Very true, and you can't tell what exact training benefit might be being gained here, but I'd be very surprised if any human can put in a line that requires a sterile gown with that amount of smoke blowing around without appropriate PPE.
0
0
4
A brilliant example of reflection / self-debrief from
@TimHarford
. Clearly states the error, explains both chain of events & context, clarifies what he was thinking / concentrating on, identifies how error was detected, makes a correction, connects it to his wider work domain.
1/ Time for an apology and a correction. Seems that every newspaper in the UK is (correctly) reporting that I said the risk of catching a fatal case of Covid-19 is about the same as the risk of having a bath. I did say that, but I was wrong. Details below.
104
489
2K
0
1
4
@grade1view
@srrezaie
with
@SaraCrager
is by far the best podcast I've heard on the acute management of RV failire
0
3
5
@Cray_tweets1
Yep, basically. The common ground between ACPs and Drs at least in EM and ICU (where I work) is RCEM / FICM accredit both the doctors and the ACPs training, so at least there is a common agency. Pay and conditions, however, are totally different 1/2
1
0
3
@Alison6123
@Megsenmumdr
Yep, and we should be doing the same with ACPs if they move clinical area. If you are working at reg grade in EM based on having years of EM nursing experience plus an ACP masters, then a new clinical area should require new training and assessment.
1
0
4
@Cray_tweets1
3/x The argument people seem to make is that in order to be an EM (for example) clinician you need a broad knowledge base, which is no doubt entirely true. What I have tried to articulate is that going to medical school for 5 years is not the only way to acquire that knowledge.
2
1
4
.
@K_G_Spearpoint
Totally agree, you didn't. Often see people in healthcare say HF and then talk exclusively about team management.
1
0
4
@Cray_tweets1
Both good points. I guess cost does come into it IF you're in a position where you can fill all your jobs. That's not the situation the NHS is in, certainly not in EM. I'd argue the main advantage of offering an ACP route to EM nurses (and select others) is staff retention 1/x
1
0
4
@kateboy
@HelenBevanTweet
@AmyCEdmondson
@tom_geraghty
Indeed - to access higher levels required system and culture change across multiple layers of an organisation. Absolutely no healthcare system I've ever been in has had anything other than the 0-2 behaviour at middle/senior management, and organisational level.
0
0
4
@ASTC108
I once spent a whole afternoon looking at every list Medway could produce of all the ICU patients. Where were about 50 possible formats. None were useful, and astonishingly none were formatted to fit on a page of copy paper.
1
0
4
@drchriscarson
@DrLindaDykes
Since I left training in 2016 I've told hundreds of people that I think there is absolutely no connection at all between the requirements of passing the training program, and actually learning to be a good Dr. I have yet to have a single person disagree...
0
0
4
Wouldn't it be amazing if this was routine practice? Obviously we might all need a bit more time in the work day to do it, but still....
0
0
4
Seems hard to convince people that a hospital admission isn't risk and side effect free...
Before admitting elderly patient 'to be safe' stop and think - is it worth aging their musculoskeletal system 10 years? Yeah, probably not.
1
34
68
2
2
4
@jltomz92
@LeechCaroline
Personally I think the phrases "stay & play" and "load & go" should be consigned to the bin. False dichotomy makes people make black and white decisions in a land of grey..l
0
0
4
@David_Menzies
@pbeaumon57
@MICAS_NASCCRS
3 mins to go mobile matches the best PHEM services on time critical primaries - you'll be slower at least to start. Increase load time to 10mins. 15min for paperwork and restock might be the median time, but some jobs will take 45mins so the mean likely more like 30min.
2
1
4
I'm amazed by the small number of people choosing the other option. I thought the balance of evidence tipped away from high chloride fluids years ago.
1
1
4
@ErgoFran
@NorthernUpgrade
@CIEHF
If anyone is interested in seeing inside pre-hospital emergency medicine or the ambulance service I can arrange/host. Not much E/HF input currently, but lost of opportunity and ideas for future work/research.
0
1
4
True for a lot of strong introverts as well - I hate group learning work and retain much less in that setting than I would on my own.
A nice pragmatic quick read. It will change at least 1 aspect of my teaching immediately
0
3
4
0
3
4
@arodrigues302
@PulmCrit
This is the key isn't it! If you treat trainees like intelligent humans who know only too well that all their attendings do not do things the same, then trainees learn various methods. Try to convince people that there is in fact ONE way and you instantly loose credibility.
0
0
3
@NikkiDQIC
@SuzetteWoodward
@hlshearer
@ShaunLintern
Is the principle always good though? Sometimes I feel we write a guideline for something because we feel we should, rather than because there is a need, or belief it will improve things. Even in avaiation not everything has a checklist, despite evidence they work.
3
4
4
So true. As someone who has taught courses on this I've still (recently) been in situations where I'm unable to speak up about safety issues because of fear of consequences, culture, and toxic micro-managing. No amount of knowledge or training can override organisational culture.
Timely piece: "Teaching healthcare practitioners to ‘speak up for safety’ will be ineffective if toxic hierarchies ...go unaddressed. Hence ... education is necessary, but insufficient, to fulfil the potential for simulation" cc
@jabfay
@LennoxHuang
#caringsafely
2
2
17
0
1
4
The next time you think about telling a team "you'll get told when you need to know..."
New Stanford study on how much leaders communicate & the impact it creates. 4 key conclusions:
1) Leaders are nearly 10X as likely to be criticised by their teams for under-communicating than for over-communicating
2) Leaders who under-communicate are seen as having less empathy
13
261
733
0
0
4
@JonJHilton
@DrLindaDykes
Or equally bad - the reflex administration of IV crystaloid to everyone with a raised lactate. When you have to explain why giving someone with a lactate of 4 from end-stage CCF is not good move something has gone wrong...
0
1
4
@ICMdoc
@WeekesLauren
This is one key component of the
@liveshq
Community Emergency Medicine Service skillset. Other CEMS/PRU teams in the UK (London, Leicester, Swansea, Oxford) would also respond to a palliative care job.
0
0
4
@traceylindeman
@DrZedZha
As both a patient and doctor I find the numeric scale totally useless outside of research. The most I ask is "a lot, a little, or in the middle". Quantification creates fake precision in your data, and forces the patient to concentrate on severity which often makes it feel worse.
0
0
4
@raddledoldtart
@davidecarroll
Depressingly this is the general quality of checklists, procedures, and other work-system interventions created for healthcare...
0
0
4
Interestingly very very different from some local guidelines...
1
5
4
More interested in
#humanfactors
now? Have at look at some excellent training from
@HumaninSystem
and
@UltraMedix
0
4
4
@d0ct0revil
@gareth_grier
All the PHEM teams I work in now (all event medicine) are taking the view that outdoors in a low risk patient they are using FFP3, eye pro, gloves. Normal hand decon after. The added benefit of a full paper suit seems tiny, if not actually zero.
1
0
4
@LeechCaroline
@WeekesLauren
@quincy516
I thinks it actually quite a popular opinion, just perhaps not with the people that dispatch or fund some services. I suspect a lot of senior PHEM clinicians (title not important) would see this as core, and important, work.
0
1
4
@Obidoc
@nic1h1
@StephenHearns1
I think
@Obidoc
has provided the complete evidence based answer here. Is there really a setting in which this is still up for debate?
2
0
4