For something officially regarded as completely unacceptable, corridor care in A&E is disturbingly common: emj.bmj.com/content/earl...
Important new study out today.
More to be done (as ever) on the interventions that matter, and those that don't. And how we improve access for those that need it most.
Thanks to good colleagues who helped to bring the paper together and support from @scotambservice.bsky.social
For what it's worth, adding into recent @drmikechristian.bsky.social, Lavery et al. meta-analysis in @sjtrem.bsky.social, via letter from @adamboulton17.bsky.social
Consistent effects of PHCC.
sjtrem.biomedcentral.com/articles/10....
No significant difference in functional outcomes. We've been fortunate to have access to these through great work from the registry - so often difficult to assess what likely matters most to patients with these methods.
emj.bmj.com/content/earl...
Pre-hospital critical care and outcomes in head injury.
It may seem obvious that early interventions save lives/change outcomes, but relatively little evidence in this group.
A wee paper just out in the EMJ
Bottom line: Association between PHCC and reduced mortality.
There's good news here, that those reaching critical care experience little harm from their isolation
Though even in Scotland, a place with a mature rural healthcare system & well-developed critical care transfer, a gap may remain in critical care provision to the most isolated
The work benefits from travel time mapping, giving a more accurate reflection of access to critical care.
Amongst the limitations are that exact routes to hospital care are unknown.
Just published at
@bjajournals.bsky.social
Geographic isolation, rurality and outcomes following critical illness.
🧑🤝🧑 >50,000 first admissions to critical care
🪦 No significant mortality differences
🏥 24% fewer admissions for the most isolated
Full-text -
authors.elsevier.com/a/1lK031dCDy...
WHO faces a 21% reduction from the original proposed budget for the 2026-27 biennium.
“If we think US$ 2.1 billion a year is ambitious—or $ 4.2 billion for the biennium—then either we must lower our ambitions for what WHO is and does, or we must raise the money.” - @drtedros.who.int
bit.ly/3ZrwCXZ
On a personal note, it's been an enormous project to get this out, and I'm hugely grateful to the co-authors. Paper available at journals.sagepub.com/doi/10.1177/...
Also demonstrates clear differences in ICU requirement across socioeconomic spectrum - almost 3x more ICU admissions for least deprived.
Adds to evidence of Inverse Care Law in emergency and critical care - resource does not match need.
Just out at Journal of the Intensive Care Society
Association between socioeconomic status and mortality from emergency admission to critical care in Scotland 2010-2011.
Grim findings, that come as little surprise. Most deprived significantly more likely to die, and to be readmitted.
Finally in print at the European Journal of Emergency Medicine. Social support from the ED, and changes in healthcare use.
Full link in the graphic.
@eusem.bsky.social @mavscotland.bsky.social
The next meeting of @ematthedeepend.bsky.social Friday 16th May 1.30pm on a theme of Alcohol and Drug-Related Harm in the ED
A great range of speakers, from clinical trials to the patient experience. If you or your team have work to share in this area, get in touch, one slot still available
South Sudan on the brink. Spoke with @telegraphnews.bsky.social recently about the tragedy and crisis of the everyday - open.spotify.com/episode/1FUI...
I cannot imagine the devastation of another war for its people.
Limitations in this type of work (see the paper), but really vital we get this part of the system right.
Just published at the Air Medical Journal.
Clinical tasking in pre-hospital critical care, and suggestion of benefits in terms of tasking numbers and call times.
A little more evidence in a relatively sparse, important field.
authors.elsevier.com/a/1knZd,OI8R...
The efficacy of the model is secure, probably now time to focus on how best to find the patients that benefit, what works on-scene, and how we maximise the efficiency
As an aside, a real demonstration of the kind support that's sometimes-forgotten in academia. @drmikechristian.bsky.social encouraged the re-analysis, which strengthens original results.
Just published in @sjtrem.bsky.social - a short re-analysis of recent work on the efficacy of physician-staffed pre-hospital critical care.
Improved precision by pooling survival + mortality outcomes, and some reassurance against publication bias.
📊 New Data Reinforces Collaboration in Pre-Hospital Care!
@ryanmchenry.bsky.social with ScotStar’s EMRS re-analyzed data from our study (doi.org/10.1186/s130...), finding survival was 41% higher for pts Tx by MD-led interprofessional teams vs. paramedics alone — with min risk of publication bias.
Looking forward to next week's @mavscotland.bsky.social conference - amongst a great lineup, we'll be talking about recent work evaluating Navigator in the ED, and how it matters to patients and a system in crisis.
Some last-minute tickets available www.eventbrite.co.uk/e/violence-p...
We're pleased to share an invite to the next meeting of @ematthedeepend.bsky.social - focussing on refugee and migrant health in the ED. We have a great range of speakers lined up, with a diversity of experience across emergency care.
Invites out soon to our mailing list, or DM for a link
Today's announcement from @msfsea.bsky.social is a stark reminder of the narrow and closing humanitarian space very close to home. Despite Europe's hope, we'll solve no problems by losing lives at sea.
Some words in the EMJ here emj.bmj.com/lookup/conte...
Grateful for the support to do this work, and maybe some small hope this might reach those with policy levers to support these important interventions.
But fundamentally, this programme appears to benefit patients and health systems. We need to seriously consider how we embed similar programmes across emergency care, with access across time-of-day, and day-of-week. Requires funding and will.
And large reductions in inpatient bed-days for frequent attenders.
Limitations: Retrospective design; difficult to conclude causal association.
Strengths: Largest study of its type; controlling for individuals' healthcare use.
More work needed (as ever); esp. health economics
journals.lww.com/euro-emergen...
We looked at >1000
@NavigatorsScot
interventions; comparing healthcare use in the year before, and the year after intervention. We show a 29% reduction in ED visits, 31% reduction in ambulance conveyance, and a shift to planned care.
Providing support for people who turn to emergency care in times of crisis feels like the right thing to do. But we still know little about how it impacts people and health systems.
A short 🧵 on a new paper with Prof. Christine Goodall in
European Journal of Emergency Medicine.
Some words on providing emergency medical care to survivors in the Central Mediterranean, while countless more lives are lost at sea. With an incredible colleague, Sofie Karlsson, and @msf.bsky.social.
Online emj.bmj.com/content/earl... or free pdf here - emj.bmj.com/content/emer...
