The St.Emlyn’s Podcast

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July 17, 2014  

Ep 9 - What can we do about targets in the ED?


It is a little known fact that to be successful as an emergency physician in the UK it is vital to take a three month rotation in Archery. Archery is a key skill for us all dating back to Medieval times when we introduced the longbow into warfare. This devastating tool could cause panic in opposing forces, scattering them into many wide and ineffective directions. In short they were an effective tool to cause and disruption inthe opposition ranks whilst the noble English armies of old strode forward with their visions of the future. Soldiers trained using targets to hone their skills and to focus on the aim - meeting the target.

Of course these days we do not have real bows and arrows in the emergency department, but archery remains alive and well. In the modern NHS we still train our troops in archery, or at least in the principle aim of archery - to meet the target.

With our long history of target setting and target hitting it is therefore no suprise that we are world leaders in standards/targets/indicators....., whichever term you prefer in fact and it has to be said that a target culture in the NHS has been criticised widely, even being blamed for the exodus of trainees to Southern climes, but there is arguably more to it than that.

In last weeks episode we touched on new targets around trauma care in the UK and that raised many questions and opened a debate on twitter. This week we want to take those thoughts further and ask what we, as the archiest of arch archers across the entire NHS can do with these externally set targets.

What we forgot to say in the podcast is the absolute need to work alongside a short stay admissions unit under the ED umbrella. Without that you would really struggle to deliver safe and efficient care. We both work in units with short stay admission units that allow us to deliver safe diagnostic and therapeutic interventions to our patients.

So, with some trepidation Iain and I ask whether all targets are a bad thing....



July 8, 2014  

Ep 8 - Trauma Team Leadership

Iain and Simon discuss the challenges of getting our trauma patients to the CT scanner within 30 minutes of arrival.

The 30 minute target is a UK standard, and we did not set it! All UK trauma centres are judged against the target and (rightly or wrongly) it has become a real issue for many centres.

We would be really be interested in what our International colleagues think about the target and the resultant strategies outlined by the team. There's more on this at the St.Emlyn's website.

As always, we'd love to hear your comments.



June 29, 2014  

Ep 7 - Delving into the Number Needed To Treat, RRR and ARR. Why we love natural frequencies

Iain and Simon chat about how we can start to translate research findings in to natural frequency summaries that help clinicians and patients alike understand the value of therapeutic interventions.

The NNT site we mention is just fantastic. Visit them here 

Great revision page here by the amazing LITFL crew 

The NNT for tranexamic acid is 67 not 50.


June 26, 2014  

Ep 6 - SMACC Back-Back on What to believe and when to change.

spockkirk.jpegHopefully you will have already seen and listened to my SMACC talk on 'What to believe and when to change'. If not then please whizz over to the site now and have a listen. I really enjoyed exploring the uncertainties that exist around when we decide to adopt or abandon therapies.

My belief is that it's really difficult to define the perfect moment and that it's only in retrospect that we can define it.

Since appearing on the ICN network and St.Emlyn's, Scott Weingart, one of the best and most innovative clinicians I know has come back and argued for early adoption. You can check out his rationale on his site and see what you think.

I actually agree with many of the things he tells us, although he has confined himself to one side of the argument. In terms of a defence of early adoption he makes a good case, but like all debates there needs to be another side to the story, so sit back and listen to why we must reflect hard on the decisions we make in deciding what we do, why we do it, and most importantly when.



June 22, 2014  

Ep 5 - Understanding diagnostics 3. Why prevalence helps us stay in practice

Iain and Simon tackle the effect of prevalence on diagnostic performance. Mrs Trellis of North Wales makes a return appearance to discuss the delicate issues of sensitivity and Rick Body joins us by mail to raise concerns about the difficulties of missing patients with myocardial disease.

Listen and enjoy, visit the blog site and keep in touch.

Don't forget to subscribe to the podcast via iTunes, to subscribe to the blog site and to like us on facebook.



June 10, 2014  

Ep 3 - Understanding diagnostics 1. SNout SpIn and Probability. St.Emlyn’s

A podcast discussing sensitivity and specificity of diagnostic tests and how we can use this in our everyday medical care of patients. 

This article from the Centre for Evidence Based Medicine is also useful. 

June 4, 2014  

Ep 2 - SMACC Chicago

The St.Emlyn's choirmaster has asked Iain and Simon to deliver a sermon on the importance of attending the SMACC Chicago conference in May 2015. After their pilgrimages to Australia in 2013 and 2014 they came back enthused and at times rather annoying about how jolly marvellous it all was. 

We felt that it was important for them to share their thoughts and to ask if anyone wishes to join them on their planned trip to the Northern Americas next year. AS Choirmaster at St.Emlyn's I have reluctantly decided to give them some air time.
I have the honour to be, as always, your most dutiful servants.
Yours etc.
The St.Emlyn's Choirmaster
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