Dr Stevan Bruijns 🏥🚑🤕🌍🏳️🌈
@codingbrown.bsky.social
PhD, UK A&E consultant (CESR), AfJEM past chief editor, NHSE South West & CQC UEC clinical advisor.
Strong views on: autonomy, mastery & belonging.
Views in posts are my own.
Strong views on: autonomy, mastery & belonging.
Views in posts are my own.
How 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)
(2/2)
March 31, 2025 at 10:32 AM
How 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)
(2/2)
No extra points for being the one and only one in your category.
✨🦄✨ 🏥🚑🚑🚑 🚑...
3/3
bsky.app/profile/codi...
✨🦄✨ 🏥🚑🚑🚑 🚑...
3/3
bsky.app/profile/codi...
𝗧𝗵𝗲 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
... 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
February 28, 2025 at 10:38 AM
No extra points for being the one and only one in your category.
✨🦄✨ 🏥🚑🚑🚑 🚑...
3/3
bsky.app/profile/codi...
✨🦄✨ 🏥🚑🚑🚑 🚑...
3/3
bsky.app/profile/codi...
𝘐𝘮𝘱𝘰𝘴𝘴𝘪𝘣𝘭𝘦 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
✨ 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
February 28, 2025 at 10:37 AM
𝘐𝘮𝘱𝘰𝘴𝘴𝘪𝘣𝘭𝘦 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
✨ 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
If you found this thread useful, please comment, like and follow.
🏥🚑🚑🚑 🚑... 🚑...
.../end
bsky.app/profile/codi...
🏥🚑🚑🚑 🚑... 🚑...
.../end
bsky.app/profile/codi...
February 8, 2025 at 7:42 PM
If you found this thread useful, please comment, like and follow.
🏥🚑🚑🚑 🚑... 🚑...
.../end
bsky.app/profile/codi...
🏥🚑🚑🚑 🚑... 🚑...
.../end
bsky.app/profile/codi...
My 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
❓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
February 8, 2025 at 7:40 PM
My 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
❓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
The 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
I call this the:
⭐Misaligned Consequences Hypothesis⭐
.../6
February 8, 2025 at 7:40 PM
The 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
I call this the:
⭐Misaligned Consequences Hypothesis⭐
.../6
So 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
🏥 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
February 8, 2025 at 7:40 PM
So 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
🏥 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
Who 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
😷 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
February 8, 2025 at 7:40 PM
Who 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
😷 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
One 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
🏥✂️ | 🚑
.../3
February 8, 2025 at 7:40 PM
One 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
🏥✂️ | 🚑
.../3
The 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
🏥🫸🚶🚶🚶🚶
.../2
February 8, 2025 at 7:40 PM
The 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
🏥🫸🚶🚶🚶🚶
.../2
If you found this thread useful, please comment, like & follow
.../end
🏥👉 👜🎒🛍️🚑 👎
bsky.app/profile/codi...
.../end
🏥👉 👜🎒🛍️🚑 👎
bsky.app/profile/codi...
February 6, 2025 at 6:40 AM
If you found this thread useful, please comment, like & follow
.../end
🏥👉 👜🎒🛍️🚑 👎
bsky.app/profile/codi...
.../end
🏥👉 👜🎒🛍️🚑 👎
bsky.app/profile/codi...