Prof. Christina Pagel Profile picture
Oct 3, 2020 8 tweets 4 min read Read on X
THREAD: many of us in healthcare have seen new IT systems hailed as gamechangers. Many don't live up to their promise. Often failure is at final step of implementation - I interviewed people at 4 hospitals who all implemented the same IT system & developed these cartoons...
The hope is that they capture typical stories of what pitfalls happen in real life - and gives tips for how to avoid them! The full cartoons (and a downloadable booklet) are freely available from @nejmcatalyst catalyst.nejm.org/doi/full/10.10… but here are some with real quotes :-)
"Because it involved IT, even tho the CMO had signed off & we had his blessing & the promised resources & the contract, then we had to go through what we call the IT gov committee. Which is not a quick process, so we had to formally present this…and that took another 6 mnths"
Key tips for avoiding the barriers above!
"Our rooms are kind of small - they're small from the standpoint of where we could put the monitors - they're not in a good spot to be able to utilize them on rounds... I would say that that's part of the frustration is the location of some of the monitors is not the best place"
"Often it's like "ta-da, we got this new thing" and it's like "oh that's [MD’s] toy…versus "okay, we're going to implement this, we're all going to own it, it's going to meaningful to everyone so what do you think about it?"
"I kept pressing for smthng I could give the nurses to say these are guidelines for using this…. [docs] didn't have a whole lot of input as to what they expected bedside nurses to use it for. And it's not that we want to ignore it ... but we also want to know how is it useful.."
Read the full piece to see all the cartoons, the tips, and download the booklet which includes a checklist! catalyst.nejm.org/doi/full/10.10…
Work done with the great @DBatesSafety & @DAGoldmann, funded by @commonwealthfnd

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More from @chrischirp

Jul 3
THREAD: Given tomorrow's election, I've been thinking about our nation's (poor) health, the wider determinants of health and how these have worsened and what it means for policy....

TLDR: worrying only about NHS & social care is missing the point

let's dive in... 1/25
The UK has a health problem. After steady gains in life expectancy for decades, it flatlined during the austerity years and fell for the first time this century with the Covid pandemic.

The number of people out of work for long term sickness is near record levels. 2/25
There are huge inequalities between rich & poor. Boys born in the most deprived areas can expect to die almost 10 years earlier than their peers in the least deprived areas.

Even worse, they can expect to spend 18 fewer years of their life in good health (52 vs 70 years) 3/25 Image
Read 38 tweets
Jun 4
As ever, I am getting lots of pushback.
Here is a compilation of the European countries I've found with recent wastewater data. Some are going up a bit, some down a bit, some are flat, none are anywhere near previous peaks.
I can't see anything here to be panic anyone. 1/3
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I can't find the dashboard for Spain, but others saying it is in a wave. Perhaps it is. England has just had one - the last data we had (a couple of weeks ago from Bob Hawkins) looked as if our wave had peaked.
So, I'm not seeing reason to think things are terrible here! 2/3 Image
Yes there are new variants growing right now. They are not growing faster than JN.1 grew in December and that wave did not end up as bad as feared.
Clearly it remains true that Covid is NOT a seasonal disease (unlike Flu and RSV)
3/3
Read 5 tweets
May 8
Quick thread on the Astra Zeneca (AZ) covid vaccine since it's been in the news today.

TLDR there isn't a new "smoking gun", the AZ vax was one of first and cheapest, it saved millions of lives globally, there are better vax out there now, adapted to new variants 1/9
the AZ vaccine was one of the first approved at the end of 2020, cheaper than Pfizer, and - importantly - easier to administer in lower resource settings as it didn't require super low temperatures for storage 2/9
In most countries it was first rolled out in older adults. As it was rolled out in younger adults, a *very rare*, serious, side effect was noticed - it could cause deadly blood clots

This was spotted quickly and studied. Vax monitoring did its job. 3/9 Image
Read 11 tweets
Apr 2
A short thread on why this is not a scary chart and why all the evidence suggests that there is not much Covid around right now. 1/6 Image
the above chart is recorded covid hospital admissions / reported covid cases. It is close to 100% now *because basically only hospitals can report cases since Feb 2024*

It is to do with changes in case reporting and NOT hospital testing
2/6
In fact hospital testing has been steady since the change in testing a year ago (only symptomatic patients get tested now).

The % of people PCR tested who have Covid is 4% - there is no evidence that there are loads of symptomatic people in hospital being missed. 3/6
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Read 6 tweets
Dec 21, 2023
Beyond a shadow of a doubt that England is in its biggest Covid wave for well over a year now, with latest ONS infection survey results published.

I've written about it here
1/7 tinyurl.com/ru7h3m28
Image
The UKHSA have now published their modelled estimates of what percentage of English population has Covid. And as of a week ago it's high (4.3%) and rising.

Read all about it here!
2/7
It's highest in London, South East and East & in young and middle aged adults.
The main thing is it's going up and fast, so prevalence will already by significantly higher now than it was last week. 3/7
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Read 8 tweets
Nov 30, 2023
Short thread on what I said on Channel 4 news tonight.

1. Did I find Hancock a sympathetic witness?

A: I find it hard to have sympathy for someone who repeatedly claimed to have thrown protective ring around care homes, while discharging covid+ patients into them.

1/5
There were *28,000* excess deaths in care homes Apr-May 2020.

Harries thought it was "clinically reasonable" not to treat covid +ve residents in hospital. Even it was, it was NOT reasonable to return them somewhere they could infect so many other very vulnerable people. 2/5
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2. Did I think scientists bear blame for not emphasising asymptomatic transmission?

A: No, because they very clearly did advise there could be asymptomic transmission before March 2020 - sources in next tweet. 3/5
Read 5 tweets

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