Marcus Lyall 📈

@CalMac_Updates Hello. Are prebooked ardrossan - Brodick tickets next week valid for Troon- Brodick or do we need to rebook?

ℹ️ From 8 Feb to 11 Feb inclusive sailings on #Ardrossan - #Brodick will temporarily operate to/from Troon. Full details and information to support customers with this change: calmac.co.uk/customer-updat…

@AnilMakam @RogueRad Fits perfectly with this! rcpjournals.org/content/clinme… Experience matters. Short admissions and (almost certainly) fewer tests with no affect on readmission or death.

Wow Just read perhaps the greatest article about a doctors’ diagnostic skills Not in the medical literature, but in an economics journal! If you think about diagnosis, follow along It won’t disappoint @RogueRad

@drfrasergibb Note improvement in TIR within a week of implementation in the treatment arm.

@jfdwolff @Clin_Med @acutemedicine @djbeckett

Experienced consultants discharge more patients from the Acute Medical Unit without increasing harm. Interesting Scottish study in @Clin_Med. More power to @acutemedicine. rcpjournals.org/content/clinme…

@kidneydoc101 @jfdwolff @Clin_Med @acutemedicine @SteveBarclay @RishiSunak Thanks Liz. I think what's remarkable is that this study actually needed done. It's a straightforward question affecting many 10s of thousands of patients a week. There is a woeful lack of research interest in multimorbid unscheduled medical care.

@jfdwolff @Clin_Med @acutemedicine Unsurprising surely? Desperately speaks to need to retain staff #NHS #StaffRetention #experiencematters @SteveBarclay @RishiSunak under your watch - staff haemorrhaging

@Marktheliverdoc @drphiliplee1 As time goes on I wonder if consultants are just less interested in asking an -ology!!! Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study rcpjournals.org/content/clinme…

There is a problem inside hospitals caused by our reliance on specialists. Day1: Plan: XXXology review Day2: Plan: await XXXology opinion Day3: Plan: Chase XXXology Its actually a "system trap" known as "shifting the burden to the intervenor". An addiction leading to bottlenecks.

@pash22 @ICULone Hopefully a positive message about the importance of investing in careers and retention of said consultants.

Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study rcpjournals.org/content/clinme… via @ICULone et al

@drol007 @PCRScommittee @nicolagwhite I used #finalfit in R. Accept no substitute! Referenced appropriately @ewenharrison

Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study rcpjournals.org/content/clinme… and forest 🌳 plot as my @PCRScommittee talk @nicolagwhite see why I mention them

@Archiejcoulter @jfdwolff @Clin_Med @acutemedicine Great question. Raised by a few people in the study. Sadly impossible to separate date of CCT from generation as they are pretty much the same thing. Await the follow up study in due course!!!!

Conclusions- Increasing consultant physician experience associates with early safe discharge after AMU admission. These data suggest that the support and retention of experienced clinicians is vital if escalating pressures on unscheduled medical care are to be addressed

@Trisha_the_doc @jfdwolff You will not have been included as an admitting consultant nowever I've no doubt you'd be responsible for some positive outcomes!!

Thank you for this @jfdwolff ! I’m trying to work out if I was one of the consultants in the study… I wasn’t doing Acute Med but as geriatricians we took over the more frail patients in AMU and discharged quite a few of them, often with Hospital at Home follow up.

@jfdwolff @Cooper00Nicola @dr_shibley @Clin_Med @acutemedicine Agree. Of course there is massive individual variation, however this study is analysed at the level of the patient, controlled for a plethora of relevant variables and grouped by consultant. There are no more thorough analyses that I am aware of in the AMU model.

@Cooper00Nicola @dr_shibley @Clin_Med @acutemedicine The study in the original tweet used experience, probably because expertise cannot easily be measured. I agree that not everyone with the same amount of experience will have the same level of expertise. I am sure the legal profession would be delighted if experts were measurable.

@jfdwolff @Clin_Med @acutemedicine Delighted this is getting some discussion. I'm afraid expertise is impossible to measure. The study was designed to analyse the effect of duration of post CCT practice.

@whitworthce The weekend AMU shift is 3 days rathet than 2 so there is more time to effect discharge. This needed inclusion as some consultants do more weekends than others. I have done the NHSL 'weekend effect' on inpatient mortality which is a nascent manuscript. Happy to chat about that.

rcpjournals.org/content/clinme… New data analysing the importance of consultant retention in medicine. Bottom line = sustainable job plans, avoidance of burnout and retention of experienced clinicians is ESSENTIAL to address increasing demand in acute medical admissions. @BMA 1/3

Valuable insight into the importance of retention in supporting flow throughout the system

@RCPEdinTrainees @RCPEdin @lothianlmc

This clearly demonstrates that maintaining experienced consultants within AMU model can improved flow, reduce A+E congestion and maintain DC safety. @goldstone_tony @BMAScotland @NHS_Lothian @hall_nhs @tegedinburgh @whitworthce @DanLasserson @acutemedicine @AndrewElder