Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 31/03/2025How about this: Become the self you’d be proud to be. Hang out with people and ideas that help you become that self. Act like that self every chance you get. (2/2) 030
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 31/03/2025𝗕𝗲 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 by Seth Godin Which self? The self you were when you were two years old, almost out of diapers? The self you were when you were screaming with the fans at the big game? The self you were after a long night? (1/2) 120
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 29/03/2025Do you ever debrief yourself with an AI agent (such as ChatGPT)? Do you ever discuss your mental health with an AI agent? After a tough shift. Or when things get tough. And you just need to talk. I do. 🗣️🤖 #EMedsky #EMsky #Medsky ai.nejm.org/doi/full/10....ai.nejm.orgRandomized Trial of a Generative AI Chatbot for Mental Health TreatmentGenerative artificial intelligence (Gen-AI) chatbots hold promise for building highly personalized, effective mental health treatments at scale, while also addressing user engagement and retention ... 130
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈African Journal of Emergency Medicine @afjem.bsky.social · 22/03/2025🚨 AfJEM Webinar Alert! 🚨 📖 Want to get published? Join us on March 26, 2025, at 1 PM CAT (GMT+2) for expert tips on mastering article writing! 📝✨ 🔗 Click to register researcheracademy.elsevier.com/work… #AfJEM #GettingPublished 021
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Adam Grant @adamgrant.bsky.social · 09/03/2025People who can’t handle criticism are unfit to lead. Weak leaders fear dissent as a threat to their power. They silence their critics to shield their egos. Strong leaders welcome dissent as an opportunity for growth. They silence their egos to learn from their critics. 1348390
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Adam Grant @adamgrant.bsky.social · 07/03/2025The hallmark of expertise is no longer how much you know. It's how well you synthesize. Information scarcity rewarded knowledge acquisition. Information abundance requires pattern recognition. It's not enough to collect facts. The future belongs to those who connect dots. 825842
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 01/03/2025No one envisions a future that’s defined by instability, declining opportunities, and a world where "least-worst" is the best we can hope for. But here we are. 🌍 🌏 🌎 🎯 010
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 28/02/2025▶️ playlist for: 𝗧𝗵𝗲 𝗙𝗼𝗿𝗲𝗶𝗴𝗻 𝗚𝗮𝘇𝗲 open.spotify.com/playlist/5K5... 041
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 28/02/2025No extra points for being the one and only one in your category. ✨🦄✨ 🏥🚑🚑🚑 🚑... 3/3 bsky.app/profile/codi... 000
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 28/02/2025𝘐𝘮𝘱𝘰𝘴𝘴𝘪𝘣𝘭𝘦 is a very large set of situations. But once something is possible, it’s unusual for there to be only one way. ✨ 𝗜𝗳 𝘆𝗼𝘂’𝗿𝗲 𝗹𝗼𝗼𝗸𝗶𝗻𝗴 𝗳𝗼𝗿 𝗮𝗻 𝗶𝗻𝘁𝗲𝗿𝗲𝘀𝘁𝗶𝗻𝗴 𝗽𝗿𝗼𝗷𝗲𝗰𝘁, 𝗮 𝘂𝘀𝗲𝗳𝘂𝗹 𝘀𝗵𝗼𝗿𝘁𝗰𝘂𝘁 𝗶𝘀 𝗳𝗶𝗻𝗱𝗶𝗻𝗴 𝘀𝗼𝗺𝗲𝗼𝗻𝗲 𝘄𝗵𝗼 𝗵𝗮𝘀 𝗮𝗹𝗿𝗲𝗮𝗱𝘆 𝗱𝗼𝗻𝗲 𝘀𝗼𝗺𝗲𝘁𝗵𝗶𝗻𝗴 𝘀𝗶𝗺𝗶𝗹𝗮𝗿 𝗮𝗻𝗱 𝘁𝗵𝗲𝗻 𝗮𝗹𝘁𝗲𝗿𝗶𝗻𝗴 𝗼𝗿 𝗶𝗺𝗽𝗿𝗼𝘃𝗶𝗻𝗴 𝗶𝘁 ✨ 2/3 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 28/02/2025𝗧𝗵𝗲 𝗹𝗼𝗻𝗲𝗹𝘆 𝘂𝗻𝗶𝗰𝗼𝗿𝗻 ... 𝘧𝘳𝘰𝘮 𝘚𝘦𝘵𝘩 𝘎𝘰𝘥𝘪𝘯 If there’s at least one unicorn in the world, it’s likely not the only one. And if one can make a valid English word from seven Scrabble tiles, it’s likely that more than one word can be found. 1/3 100
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈African Journal of Emergency Medicine @afjem.bsky.social · 28/02/2025𝗔𝘁𝘁𝗲𝗻𝘁𝗶𝗼𝗻 𝗮𝘀𝗽𝗶𝗿𝗶𝗻𝗴 𝗮𝘂𝘁𝗵𝗼𝗿𝘀 Aspirant African EM authors who either have a dissertation to publish, or a first time research publication An hour long webinar, with pointers and pearls, key resources and Q&A Register here: researcheracademy.elsevier.com/workshop/b64... #Medsky #EMedsky #EMsky 🌍📝🤓 022
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 27/02/2025I sat in the audience at Africa's first emergency medicine conference in South Africa in 2011 when Joe O'Neil related in a keynote how PEPFAR came about. Joe wrote this editorial for @afjem.bsky.social, a journal I edited at the time. Well worth a read. 😢 www.sciencedirect.com/science/arti...sciencedirect.comTaking Acute Care Worldwide: Pragmatic lessons from the HIV pandemic 020
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Adam Grant @adamgrant.bsky.social · 21/02/2025The loudest voices rarely represent the majority. They're usually speaking for the extremes. You won't understand the views of a group until you've invited the quieter voices into the discussion. Don't mistake silence for disengagement. It's often a sign of deep reflection. 435754
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Adam Grant @adamgrant.bsky.social · 13/02/2025Productivity is overrated. What counts most is the quality of output, not the quantity. People may be impressed by the volume you produce, but impact depends on the value you create. Success is not about getting more things done. It's about doing more worthwhile things well. 1029940
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025If you found this thread useful, please comment, like and follow. 🏥🚑🚑🚑 🚑... 🚑... .../end bsky.app/profile/codi... 010
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025My guess is that as long as incentives and consequences remain misaligned, ambulance handovers will likely remain challenged ❓Does the hypothesis align with your observations? ❓Or do you think other factors play a bigger role? ❓What would introduce natural consequences for inpatient teams? .../7 310
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025The natural consequence of access block falls on A&E teams, ambulance teams and patients, not the responsible teams, meaning there is less direct urgency for those responsible for bed availability to act. I call this the: ⭐Misaligned Consequences Hypothesis⭐ .../6 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025So who then is responsible for admission access? 🏥 Inpatient teams: discharging patients efficiently and making beds available. 📋 Hospital management: ensuring smooth patient flow. 🏘️ Community care services: providing reliable out-of-hospital healthcare services. .../5 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025Who does experience the direct consequence? 😷 A&E teams: crowding, patient backlogs, and strained staff. 🚑 Ambulance crews: stuck waiting outside hospitals instead of responding to new emergencies. 🤕 Patients: delayed treatment and worse health outcomes. .../4 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025One major reason this persists is because the teams with agency over inpatient beds do not directly experience any of the direct consequences of access block. 🏥✂️ | 🚑 .../3 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025The issue of ambulance handover delay in the NHS is largely a symptom of access block, where admitted patients cannot be moved from A&E due to the weak availability of inpatient beds. 🏥🫸🚶🚶🚶🚶 .../2 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 08/02/2025On misaligned incentives and consequences in urgent and emergency care (UEC) 🏥🚑🚑🚑 🚑... 🚑... .../thread #Medsky #EMedsky #EMsky 262
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025If you found this thread useful, please comment, like & follow .../end 🏥👉 👜🎒🛍️🚑 👎 bsky.app/profile/codi... 021
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025True productivity requires clear role boundaries, better interdepartmental coordination and proper resource allocation, so that every specialty team can handle its own specialised workload effectively. ⚙️ 🏥🚑🚑🚑 🚑... .../7 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025🤕 3. Wasting Specialist Skills: emergency clinicians spending time on non-emergency tasks lead to suboptimal patient care. 🥵 4. Increasing Burnout: constantly stretching beyond core roles lead to staff fatigue and decreased overall performance. 🏥👉 👜🎒🛍️🚑 👎 .../6 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025👈 1. Diverting Focus: taking time away from core emergency care leads to longer waiting times and reduced efficiency. 📈 2. Causing Bottlenecks: overloading A&E with non-urgent tasks slows down patient flow and increases overcrowding. .../5 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025Shifting specialised responsibility to an overburdened, less specialised service is just as unproductive as it sounds on paper. Using A&E as an example, specialised responsibilities passed on from specialties reduce A&E productivity by: .../4 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025Specialty productivity is not improved by shifting specialised responsibility to less specialised services. Although this improves the specialty's efficiency, it reduces the less specialised service's efficiency, and system productivity overall. 😇👉 👜🎒🛍️😫 👎 .../3 110
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025Improving productivity means delivering high-quality patient care, through optimising staff, reducing administrative burdens and leveraging digital tools. It’s about working smarter, ensuring the right people do the right tasks, best suited to them, efficiently. 😷📏🖥️ 👍 .../2 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 06/02/2025On what is not a service productivity improvement... ⚙️ 🏥🚑🚑🚑 🚑... /Thread... #Medsky #EMedsky #EMsky 162
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Adam Grant @adamgrant.bsky.social · 31/01/2025It takes curiosity to learn. It takes courage to unlearn. Learning requires the humility to admit what you don't know today. Unlearning requires the integrity to admit that you were wrong yesterday. Learning is how you evolve. Unlearning is how you keep up as the world evolves. 16744174
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Anthony Lau, PharmD BCPS @alaurx.bsky.social · 31/01/2025Patient self-directed sliding scale furosemide is an underutilized tool in CHF management Can a simple weight-based dosing strategy empower patients to manage CHF, prevent exacerbations, and reduce ED visits? Let's dive in! 👇 #medsky #pharmsky #cardiosky #EMsky #GPsky #MedEd 1/media.tenor.coma person is measuring their weight on a scale that goes up to 40ALT: a person is measuring their weight on a scale that goes up to 40 5207
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 31/01/2025⭐NHSE planning guidance published 30 January⭐ Much of investment to improve flow through ED to be targeted outside ED. Have a read and post your thoughts. 🏥🚑🚑🚑 🚑... #Medsky #EMedsky #EMsky 🔗https://www.england.nhs.uk/long-read/2025-26-priorities-and-operational-planning-guidance/ 010
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈steve the skeptic @policyskeptic.bsky.social · 27/01/2025Long waits in A&E kill patients. Maybe a thousand every month. The recent ONS analysis has issues but makes the problem look worse than previous analyses: www.hsj.co.uk/daily-insigh...hsj.co.ukThe mythbuster: Do not ignore this second warning of the deadly impact of long A&E waitsSteve Black examines the ONS' new analysis linking long A&E waits to rising patient mortality, highlighting the urgent need for NHS action to tackle the crisis of excessive delays and their fatal ... 21711
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 24/01/2025I think what would be helpful for busy ED CSLs is being able to pull 3 or 4 data points from the various existing data sets (SEDIT, ECDS, etc) that can help them making solid arguments around the above. 000
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Prof. Damian Roland @damianroland.bsky.social · 03/01/2025Observation is an investigation My #DFTB23 Keynote talk. Spoiler: The decision to observe needs to be an active one, not just a process to avoid making a decision. www.youtube.com/watch?v=wtIw... 152
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈steve the skeptic @policyskeptic.bsky.social · 22/01/2025When the ONS analysis of relative mortality vs waiting times in A&E departments was published last week they omitted some critical information. But the pattern of higher mortality with longer waits was very clear... 2107
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈steve the skeptic @policyskeptic.bsky.social · 23/01/2025Sometimes senior NHSE leaders say things that accidentally reveal the biggest reasons why they can't fix major NHS problems. This speech from Steve Powis is an example: www.independent.co.uk/news/uk/step... ...independent.co.uk‘A&Es will treat equivalent of half the population each year without reform’Sir Stephen Powis has urged people to engage with the national conversation about the future of the health service. 1136
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 24/01/2025Hi Steve, great thread. Can you post some references/ reference links for this post. 100
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 24/01/2025Solving crowding in A&E: Reduce attendances or improve flow though hospital beds? 🧵👇 #EMedsky 130
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Seth Godin @sethgodin.bsky.social · 21/01/2025Kinds of incompetence The second worst is the unaware sort. The work doesn't meet spec, and we don't even realize it. The worst is uncaring. We know the work doesn't meet spec, but we don't bother to fix it. But there are other varieties, and some are worth seeking out: There's the incompetence of…seths.blogKinds of incompetenceThe second worst is the unaware sort. The work doesn't meet spec, and we don't even realize it. The worst is uncaring. We know the work doesn't meet spec, but we don't bother to fix it. But there are other varieties, and some are worth seeking out: There's the incompetence of creativity and art, where the spec isn't the point. … 0192
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈African Journal of Emergency Medicine @afjem.bsky.social · 19/01/2025🔥 Hot off the press: Empowering emergency nursing in Africa through research buff.ly/3DY4cx5 #Medsky #EMedskybuff.ly 031
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 18/01/2025The ONS statistically corrected for degree of sickness. This is higher deaths linked to longer time spent in A&E. It would not exist if patients spent less than 4 hours, as they ought to. 000
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈Royal College of Emergency Medicine @rcem.ac.uk · 17/01/2025“There must be a point where we go beyond analysis and accept that this is a serious problem that needs urgent political action.” RCEM's President responds to ONS research concluding patients who wait in A&E for more than two hours are exposed to an increasing risk of death - tinyurl.com/5fkpp4b6 12923
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 17/01/2025Relationship between ⌚ spent in A&E & odds of 30-day, post-discharge, all-cause mortality: Compared with patients who spent 2h in A&E, the odds of post-discharge death were: 🕒 1.1 x ☝️ if spent 3h 🕕 1.6 x ☝️ if spent 6h 🕘 1.9 x ☝️ if spent 9h & 🕛 2.1 x ☝️ if spent 12h #EMedsky 🔗 shorturl.at/Tvw9eshorturl.atAssociation between time spent in emergency care and 30-day post-discharge mortality, England - Office for National StatisticsRelationship between time spent in A&E and the odds of 30-day, post-discharge, all-cause mortality, controlling for other factors. 032
Reposted by Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈tjcoats.bsky.social @tjcoats.bsky.social · 07/01/2025We are not documenting crowding in individual patient notes. Makes it difficult to give context around delayed care for coroner, solicitor etc Do you document crowding in clinical notes? If so what phrases do you use? 243
Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈 @codingbrown.bsky.social · 07/01/2025🙌 Essential Leadership Tips for 2025 Are challenges like communication and culture puzzling you? Start the new year strong with leadership advice from MIT SMR experts. sloanreview.mit.edu/article/10-e...sloanreview.mit.edu10 Essential Leadership Tips for 2025Use these strategies to build your leadership skill set and solve tough challenges in the new year. 000