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“Focus on consistent habits & great cadence before marginal gains.”
Figure at some point you need a motto in life that you can stick to.
It’s not catchy but I think it’s true!
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Stuart Nuttall
5.3K posts
Stuart Nuttall
@StuartNuttall1
Manservant to Bella and Lachlan. 🏊♂️ 🚵♂️ 🏃♂️ Du&Triathlete. EM Consultant. Part of the @CEMBooks team ⭐️Finlay⭐️
Yorkshire Katılım Ocak 2012
1.6K Takip Edilen1.1K Takipçiler
In an out of work through these areas this weekend on new dedicated clean traffic free cycle lanes too - can’t complain 👌
Tom Forth@thomasforth
Greatest city on earth.
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Stuart Nuttall retweetledi
🚨NEW POST BY ME🚨
Greater Manchester’s growth success is real, but didn't happened by accident. The country should be studying it closely.
Long-term strategy that is aggressively pro-growth, pro-development & pro-FDI works if given time and consistency
substacktools.com/sharex/8x1zxD4F
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@kurtstat They are the widely regarded benchmarks people test themselves against I’d say.
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This happens to be a distribution of finishing times at the 2019 London Marathon, but I think it's a pattern we see in all marathons. The sudden spikes (at 02:59, 03:29 and 03:59, for example) are much more evident for men than for women.
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@kurtstat @TJCoats Could probably add in for both graphs - marginal gains thinking is only the icing on the cake for both marathon and ECS performance. You’ve got to get the basic processes sorted/base miles in to build that solid cake before tinkering with the bits round the edges/fancy decoration
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I've rashly said I'll do a 10-minute talk on the topic of "Endurance" at a local storytelling event on Friday. I thought I'd use this pair of graphs as my theme (thanks to @TJCoats for planting the idea a few weeks ago!). Anyone got any good 'compare-and-contrast' suggestions?
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@davehartin 🙋♂️ ER was big for me!
Just got HBO max so have seen the first couple of S1 episodes of The Pitt so far….
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This is a common theme re EPs & "The Pitt". Heard it at the RCEM conference too.
There is a large cohort of EPs who presumably grew up on a diet of ER, know by report how good a drama it is but cannot bear to watch it for... reasons...
I'm one of them. This should be a worry.
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@kurtstat @fourhourtarget @RCEMPolicyVP @RCEMpresident @TJCoats 😂 not generally 4hr ECS, but yes to many other processes esp if they’re done as part of a quality improvement process.
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Do managers use control charts like this to describe four-hour compliance in your ED?
@fourhourtarget @StuartNuttall1 @RCEMPolicyVP @RCEMpresident @TJCoats
Neil Pettinger@kurtstat
Might be wrong. Hope I am. But I worry that NHS managers often use control charts to monitor dysfunctional processes so that they can reassure themselves how 'in control' those dysfunctional processes are.
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Stuart Nuttall retweetledi
At what level do you even pitch political coverage to a nation which thinks the NHS makes a 34% profit margin whilst not charging them for anything?
camilo@AscendedYield
the general public overestimate the margins businesses make
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Stuart Nuttall retweetledi
"As an unabashed socialist, I am concerned with the distribution of wealth, but if you don’t create any in the first place it is a bit of an empty discussion." > Sir Richard Leese. If there is a meaningful concept of "Manchesterism" then this would be it for me.
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@kurtstat @DrGillespie_GP @sib313 @RCEM_VP @RCEMPolicyVP @fourhourtarget @TJCoats @whitefleece8127 @nickscr1 @BDChadwick @jfdwolff How many clinicians outside of EM are really into flow & how it affects their ward/specialty/the org as a whole rather than just the clinical management of their patients on their ward? Genuinely unsure. By nature it’s part of EM training, not sure it is in other specialties tho
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@DrGillespie_GP @sib313 @RCEM_VP @RCEMPolicyVP @fourhourtarget @StuartNuttall1 @TJCoats @whitefleece8127 @nickscr1 @BDChadwick @jfdwolff Information should make clear - for each directorate/ department - the relationship between admissions, length of stay and bed occupancy. And how small changes in these can have a big impact on flow. It's probably best if the data is owned by clinicians rather than 'management'.
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First draft of a new slogan: "Tough on exit block, tough on the causes of exit block."
@RCEM_VP @RCEMPolicyVP @fourhourtarget @StuartNuttall1 @TJCoats @whitefleece8127 @nickscr1 @BDChadwick @jfdwolff
Neil Pettinger@kurtstat
Hospitals know that poor patient flow is caused by beds being too full. They also know that when they make the beds less full, flow improves. But they treat bed fullness as a thing that just 'happens'. We need an approach to flow that addresses the *causes* of bed fullness.
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@kurtstat @TJCoats @RCEM_VP @RCEMPolicyVP @fourhourtarget @whitefleece8127 @nickscr1 @BDChadwick @jfdwolff And maybe “don’t put off till tomorrow what can be done today”!!
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@TJCoats @RCEM_VP @RCEMPolicyVP @fourhourtarget @StuartNuttall1 @whitefleece8127 @nickscr1 @BDChadwick @jfdwolff That quote reminds me of an adapted quote I once saw: "Content is King. But Queen is Design." And I'm now wondering if I want to similarly adapt "Flow is King" by adding: "But Queen is Length of Stay"!
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@philatrail wakefieldexpress.co.uk/news/transport…
Looks like the travel data backs it up. Seems to be well used!!
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@philatrail The Picc - York via Cas should be a no brainier to avoid Leeds and link Wakefield to Manchester. No other service provides that link currently and it seems well used.
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Indicative future trans-Pennine timetable. 2tph Liverpool-Newcastle/Scarborough, 2tph Manchester Airport-Newcastle/Saltburn, 2tph Man Picc-Hull semi-fast, 2tph stopper Picc-Huddersfield and Huddersfield-Leeds. Missing is Picc-York via Castleford, it’s still in the balance.
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Stuart Nuttall retweetledi
I usually illustrate my Heaviness Hypothesis* with AMU data. But I wondered if ED heaviness explains ED length of stay better than mere ED fullness does. And it does! (Though it's marginal!)
(*ED exit block is better explained by AMU heaviness than it is by mere AMU fullness.)
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Stuart Nuttall retweetledi
"To thrive, Britain must embrace failure: If London, Oxford, and Cambridge continue to know that they are too big and too cherished to fail, Britain will not thrive. It is neither unpatriotic nor populist (as Burnham was accused of being) to say so." tomforth.co.uk/embracefailure/
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Stuart Nuttall retweetledi
The peerless Professor Harold Ellis died yesterday at 100 years old. I am sure he would want us to celebrate his life by sharing his teaching. He was a wonderful wonderful man, take 9 minutes to learn the plexus from him - youtu.be/R63TkIj0rnY
YouTube
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Stuart Nuttall retweetledi
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026
CCR Journal Watch
criticalcarereviews.com/latest-evidenc…
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Stuart Nuttall retweetledi
Clinical deterioration is an underappreciated risk of ED boarding.
In a multi-center study of >173,000 admissions, nearly 1 in 25 ED boarders admitted to the floor experienced early clinical deterioration requiring an admission to an advanced level of care, with almost half occurring before leaving the ED. Each additional hour of boarding was independently associated with an increased risk of deterioration, and deterioration carried substantially higher 28-day mortality.
Identifying high-risk patients early may prevent avoidable escalations in care and patient harm.
#EDBoarding #PatientSafety #EmergencyMedicine #EM #HealthPolicy #SocialMedicine
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This wouldn’t be news to anyone who had the old @hornby Percy model train.
Was the fastest model engine on our railway 🚂 💨 🟢
Chandlers_Railway (Commisions Open)@Mr_C_Railway
I got Percy to 143 MPH in Wonders of Sodor
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Stuart Nuttall retweetledi
The association between long emergency department stays and inpatient length of stay: a retrospective cohort study | BMC Emergency Medicine | Springer Nature Link. Published today by my residents. Another harm of long ED stays… 1/n link.springer.com/article/10.118…
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It’s not just a UK phenomenon though @kurtstat - have a listen to the latest @SGem podcast. Similar issues, with some different terminology (alternate levels of care = no reason to reside) but essentially the same problem and same results - higher mortality and burnout etc.
Ken Milne MD@TheSGEM
SGEM#503: Waiting is the Hardest Part – Factors Associated with Emergency Department Length of Stay. thesgem.com/2026/02/sgem50… @PfParks @CAEP_Docs @alandrummond2 @raghu_venugopal
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@kurtstat @StuartNuttall1 This is the nail on the head! If WE get it, why isn’t it being tackled? Instead we pile more and more pressure on the front end!
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Ask NHS managers why emergency department four-hour performance has deteriorated so much over the last few years, and the most common reply is: “It’s the delayed discharges, stupid!”
And when you look at the two indicators together on the same graph, it’s hard to disagree.
1/3
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