Tom Bircher
@tombircher.bsky.social
EM Doctor, Corridor Medic, Medical Rotas and workforce, data and clinical ops #FOAMed
We’ve released our clinical fellow jobs.
These are great if you’ve finished F2 but aren’t sure what’s next.
Self rostered.
20% Non-clinical time.
We get consistently excellent feedback for them
www.jobs.nhs.uk/candidate/jo...
These are great if you’ve finished F2 but aren’t sure what’s next.
Self rostered.
20% Non-clinical time.
We get consistently excellent feedback for them
www.jobs.nhs.uk/candidate/jo...
Job Advert
www.jobs.nhs.uk
April 10, 2025 at 5:34 PM
We’ve released our clinical fellow jobs.
These are great if you’ve finished F2 but aren’t sure what’s next.
Self rostered.
20% Non-clinical time.
We get consistently excellent feedback for them
www.jobs.nhs.uk/candidate/jo...
These are great if you’ve finished F2 but aren’t sure what’s next.
Self rostered.
20% Non-clinical time.
We get consistently excellent feedback for them
www.jobs.nhs.uk/candidate/jo...
Here is a list of people who I have been told should be prioritized for early assessment in the emergency department:
March 17, 2025 at 2:49 PM
Here is a list of people who I have been told should be prioritized for early assessment in the emergency department:
If you were wanting to save a bit more money you could always reduce NHS111 opening hours to 06:00 —> 23:00 rather than 24/7
March 16, 2025 at 12:17 PM
If you were wanting to save a bit more money you could always reduce NHS111 opening hours to 06:00 —> 23:00 rather than 24/7
What’s the BEST way of doing emergency department resident doctor teaching?
March 9, 2025 at 12:12 PM
What’s the BEST way of doing emergency department resident doctor teaching?
Hi everyone.
If you happen to be an on call doctor for a speciality can I remind you that *you* are not responsible for finding a bed for a patient. That is the job of the hospital ops/site team.
If you happen to be an on call doctor for a speciality can I remind you that *you* are not responsible for finding a bed for a patient. That is the job of the hospital ops/site team.
February 15, 2025 at 2:22 PM
Hi everyone.
If you happen to be an on call doctor for a speciality can I remind you that *you* are not responsible for finding a bed for a patient. That is the job of the hospital ops/site team.
If you happen to be an on call doctor for a speciality can I remind you that *you* are not responsible for finding a bed for a patient. That is the job of the hospital ops/site team.
A 64 yo man with HTN, pAF, on a rhythm control strategy attends ED. He went into AF 10 hrs ago. Flecainide hasn’t worked. He’s anticoagulated. He’s fasted.
Obs ok - HR 106.
What would you do?
Obs ok - HR 106.
What would you do?
February 12, 2025 at 7:38 AM
A 64 yo man with HTN, pAF, on a rhythm control strategy attends ED. He went into AF 10 hrs ago. Flecainide hasn’t worked. He’s anticoagulated. He’s fasted.
Obs ok - HR 106.
What would you do?
Obs ok - HR 106.
What would you do?
We had a good week performance wise, we got asked “what we did differently”
The ED did nothing differently, the hospital accidentally kept open more beds than normal.
For this period we had flow.
Of course now that extra capacity has now been closed. Guess what’s happened to performance?
The ED did nothing differently, the hospital accidentally kept open more beds than normal.
For this period we had flow.
Of course now that extra capacity has now been closed. Guess what’s happened to performance?
February 11, 2025 at 8:49 PM
We had a good week performance wise, we got asked “what we did differently”
The ED did nothing differently, the hospital accidentally kept open more beds than normal.
For this period we had flow.
Of course now that extra capacity has now been closed. Guess what’s happened to performance?
The ED did nothing differently, the hospital accidentally kept open more beds than normal.
For this period we had flow.
Of course now that extra capacity has now been closed. Guess what’s happened to performance?
So this document is fun. And it’s an excellent idea from RCEM. I’m thankful for it.
In it it suggests that no more than 10% of patients in the ED should be lodged for a bed at any one time.
rcem.ac.uk/wp-content/u...
In it it suggests that no more than 10% of patients in the ED should be lodged for a bed at any one time.
rcem.ac.uk/wp-content/u...
rcem.ac.uk
February 9, 2025 at 6:13 PM
So this document is fun. And it’s an excellent idea from RCEM. I’m thankful for it.
In it it suggests that no more than 10% of patients in the ED should be lodged for a bed at any one time.
rcem.ac.uk/wp-content/u...
In it it suggests that no more than 10% of patients in the ED should be lodged for a bed at any one time.
rcem.ac.uk/wp-content/u...
Reposted by Tom Bircher
Sometimes 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... ...
www.independent.co.uk/news/uk/step... ...
‘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.
www.independent.co.uk
January 23, 2025 at 3:53 PM
Sometimes 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... ...
www.independent.co.uk/news/uk/step... ...
If you go for a quiet pre-nights walk in the Peak District alone how many emergency medicine consultants will you meet?
January 20, 2025 at 12:42 PM
If you go for a quiet pre-nights walk in the Peak District alone how many emergency medicine consultants will you meet?
Hope everyone is working on their 25/26 winter plans now.
Cos this winter is now set, and there is nothing anyone can do.
- bigger assessment spaces
- surge ward staffing
- flexible rostering (term time contracts?)
- summer training programmes
Cos this winter is now set, and there is nothing anyone can do.
- bigger assessment spaces
- surge ward staffing
- flexible rostering (term time contracts?)
- summer training programmes
January 10, 2025 at 8:17 AM
Hope everyone is working on their 25/26 winter plans now.
Cos this winter is now set, and there is nothing anyone can do.
- bigger assessment spaces
- surge ward staffing
- flexible rostering (term time contracts?)
- summer training programmes
Cos this winter is now set, and there is nothing anyone can do.
- bigger assessment spaces
- surge ward staffing
- flexible rostering (term time contracts?)
- summer training programmes
So at work we have a demand/supply mismatch
We need an extra 60 or so beds from about 11 am until about midnight.
This would absorb most of the predictable inflow while we wait for the predictable discharges (or surge ward)
Anyone used a model where an admission unit expands and contracts?
We need an extra 60 or so beds from about 11 am until about midnight.
This would absorb most of the predictable inflow while we wait for the predictable discharges (or surge ward)
Anyone used a model where an admission unit expands and contracts?
December 16, 2024 at 7:26 PM
So at work we have a demand/supply mismatch
We need an extra 60 or so beds from about 11 am until about midnight.
This would absorb most of the predictable inflow while we wait for the predictable discharges (or surge ward)
Anyone used a model where an admission unit expands and contracts?
We need an extra 60 or so beds from about 11 am until about midnight.
This would absorb most of the predictable inflow while we wait for the predictable discharges (or surge ward)
Anyone used a model where an admission unit expands and contracts?
Reposted by Tom Bircher
(1st Bluesky post)
Our members are seriously worried about being able to keep patients safe this winter.
RCEM President: “We speak of percentages and numbers but let’s remember we are talking about people, and a workforce running on fumes trying to do their best..."
tinyurl.com/bssSnapSurvey
Our members are seriously worried about being able to keep patients safe this winter.
RCEM President: “We speak of percentages and numbers but let’s remember we are talking about people, and a workforce running on fumes trying to do their best..."
tinyurl.com/bssSnapSurvey
November 18, 2024 at 10:03 AM
(1st Bluesky post)
Our members are seriously worried about being able to keep patients safe this winter.
RCEM President: “We speak of percentages and numbers but let’s remember we are talking about people, and a workforce running on fumes trying to do their best..."
tinyurl.com/bssSnapSurvey
Our members are seriously worried about being able to keep patients safe this winter.
RCEM President: “We speak of percentages and numbers but let’s remember we are talking about people, and a workforce running on fumes trying to do their best..."
tinyurl.com/bssSnapSurvey
Anyone put a local-only LLM on a NHS laptop?
November 18, 2024 at 8:19 AM
Anyone put a local-only LLM on a NHS laptop?
Reposted by Tom Bircher
One part of our upgraded infrastructure may affect your profile.
If you see your handle now says “Invalid handle,” please reverify it by navigating to Settings > Change my handle > Type in your current handle > Verify DNS Record > Update.
(Basically, update to the same handle.)
If you see your handle now says “Invalid handle,” please reverify it by navigating to Settings > Change my handle > Type in your current handle > Verify DNS Record > Update.
(Basically, update to the same handle.)
August 18, 2023 at 9:35 PM
One part of our upgraded infrastructure may affect your profile.
If you see your handle now says “Invalid handle,” please reverify it by navigating to Settings > Change my handle > Type in your current handle > Verify DNS Record > Update.
(Basically, update to the same handle.)
If you see your handle now says “Invalid handle,” please reverify it by navigating to Settings > Change my handle > Type in your current handle > Verify DNS Record > Update.
(Basically, update to the same handle.)
Emergency department overcrowding is caused by patients waiting for beds.
It is not caused by
-inappropriate attendances
-ambulant urgent patients
Lack of beds is a NURSE STAFFING issue rather than a physical problem with not enough space/kit.
It is not caused by
-inappropriate attendances
-ambulant urgent patients
Lack of beds is a NURSE STAFFING issue rather than a physical problem with not enough space/kit.
November 14, 2024 at 7:37 AM
Emergency department overcrowding is caused by patients waiting for beds.
It is not caused by
-inappropriate attendances
-ambulant urgent patients
Lack of beds is a NURSE STAFFING issue rather than a physical problem with not enough space/kit.
It is not caused by
-inappropriate attendances
-ambulant urgent patients
Lack of beds is a NURSE STAFFING issue rather than a physical problem with not enough space/kit.
Perfectly happy with hospital league tables.
But can we have different leagues? For example my local children’s hospital always smashes us at the 4 hr target which is due to vastly different patient characteristics.
But can we have different leagues? For example my local children’s hospital always smashes us at the 4 hr target which is due to vastly different patient characteristics.
November 13, 2024 at 7:35 AM
Perfectly happy with hospital league tables.
But can we have different leagues? For example my local children’s hospital always smashes us at the 4 hr target which is due to vastly different patient characteristics.
But can we have different leagues? For example my local children’s hospital always smashes us at the 4 hr target which is due to vastly different patient characteristics.
Hello everyone.
I’m Tom, an EM consultant with a massive attitude problem who has got sucked into the world of medical IT.
I generally post about flow, data, and Doctor rotas.
I’m Tom, an EM consultant with a massive attitude problem who has got sucked into the world of medical IT.
I generally post about flow, data, and Doctor rotas.
November 11, 2024 at 7:10 PM
Hello everyone.
I’m Tom, an EM consultant with a massive attitude problem who has got sucked into the world of medical IT.
I generally post about flow, data, and Doctor rotas.
I’m Tom, an EM consultant with a massive attitude problem who has got sucked into the world of medical IT.
I generally post about flow, data, and Doctor rotas.
This seems like a safe place to say that this is my favourite normogram but to use it you need to know the LR and be comfortable with pre-test probability.
Clinicians are sh*t at estimating pre-test probability (they generally over-estimate), and it’s really hard to find a LR in the literature
November 11, 2024 at 8:04 AM
This seems like a safe place to say that this is my favourite normogram but to use it you need to know the LR and be comfortable with pre-test probability.
Clinicians are sh*t at estimating pre-test probability (they generally over-estimate), and it’s really hard to find a LR in the literature
August 18, 2024 at 4:25 PM