Sam Goodhand
@SamGoodhand
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Dr in ICU & anaesthesia. News column contributor. Checklist card concept creator. Ex-A&E & Outback flying doctor.Keen traveller, reader & kitesurfer.
United Kingdom
Joined April 2018
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Crash intubation in A&E the other night. Urgent ++, so we observe a shortened checklist.
20 seconds later we’re ready to RSI, having identified suction not switched on.
If you think you don’t have time to do the checklist, the more you need to do it.
#patientsafety
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Surprised how few people know this little “hack” for giving salbutamol down your asthmatic or COPD patient’s ET tube… 🫁
All you need is a 50ml syringe & their inhaler (disclosure - not my idea!)
#medtwitter
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It irritates me when people believe safety checklists (eg.for intubation) are only for inexperienced staff.
I got distracted & forgot to put deodorant on this morning. I must have got myself ready 10,000 times in the past.
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Crash intubation of a very sick patient last night, in a remote corner of the hospital. No checklist available but the mini-checklist card kept things safe - the very scenario which inspired the idea. With
@dasairway
support, our cards will soon be in hospitals nationwide
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A medical student recently observed me inserting a central line on ITU, which I just couldn’t get in.
Initially it seemed a wasted opportunity, until we discussed how little training we get in inevitable failure. A few pointers from somebody experienced in failing:🧵
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Turns out walking past a colleague in scrubs with a rucksack on and exclaiming “Backpack Wanker!” is best saved for a post-mask era, when you definitely have the right person. 🎒
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When I tell lay people what it’s like attending ward / A&E emergencies and locating urgent bits of kit, I get them to imagine going into a new and unfamiliar supermarket every day for a week to find the eggs in under 60 seconds.
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Did a 2AM emergency cardioversion in Resus this week.
I felt exhausted, rotten man flu 🤧. Nearly overlooked the O2 being off, but A&E nurse pulls out a pre-procedure prompt card which took 10 seconds. Successful, safe procedure.
Checklists are good ✅
#humanfactors
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“Hospital bosses are said to have denied anyone consumed the cake”. A tall claim, from anybody who’s seen how long a cake lasts in a ward staff room. 🧐
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Shortening medical school to 4 years is a great idea.
Let’s reduce waiting lists by shortening every operation by 20%, too. Reckon the public will like the sound of that?
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Every anaesthetic room has crucial stuff in different places.
I’ve never been in an A&E resus with the same layout as another, or a standardised storage system.
Then there’s stationery & cannula kit on wards🙄
The stress is real. Why do we so openly ignore ergonomics?
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And at med school they’ll learn that you can fixate on pouring in unit after unit of blood transfusion, but very soon you’ll need someone who can actually stop the bleeding.
#nhs
The Tories failed to train enough doctors over 13 years.
Now patients are told to get on their bike to see a GP.
We will double medical school places so patients can easily book appointments to see the GP they want, in the manner they choose.
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Looks like doctors are finally going to be outed on ICU.
We haven’t got the faintest clue about haemofilters. 🧐
#NursesStrike
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A few thoughts on the
#QRH
handbook & checklists.
3 yrs ago I gave a Gen Anaesthetic for an emergency C-section. I was alone, it was 3am, and it was mid-Covid. The young woman ventilated well at first, then didn’t. Tiny volumes, quiet chest. I took as read the normal ET CO2 🫁1/
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Is it possible in the nuance-free world of Twitter to say I have huge respect & appreciation for my paramedic & ACCP colleagues, but as an ICU staffing solution this is a very worrying direction of travel?
#NHS
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How often do you hear this during the WHO surgical brief?
“Team introductions? Na I think we all know each other, let’s move on”. 👀
Half the time we don’t, and it’s worth doing properly.
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Every day is a school day.
Have you noticed some formerly feral rescue cats with one ear cleanly tipped? This clue (modeled handsomely here by Kennedy at
@MtlARN
) means someone loved that cat without even knowing them. It’s a sign of a TNR program: trap, neuter, release
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3. Ask for help, and don’t just keep retrying a procedure. After a couple of attempts I asked my colleague to try the line.
I have greater respect for the colleague who asks for fresh eyes after 3 failed attempts, than the one who proclaims success on the sixth.
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Final thoughts:
-We’re more fallible than we think, ⬆️ when tired.
-Use the checklists in an emergency,even if only to check you’ve done everything.
-Drs, ODPs etc should be regularly reminded of them,so use is 2nd nature.
-Checklists enable, not threaten, your skills 🧠
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Some sick patients to intubate this week on ICU nights. Kept safe by a solid team & our checklist cards - worn by all our airway Drs,snr nurses & Outreach.
We hope the new paediatric card will overcome checklist availability issues with the same success!
#checklist
#GAMC2021
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2. Failure happens at all level of experience, even if it becomes less common over time.
If you can remember this you’ll manage these situations more calmly and with far less stress
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“We just need you to do a quick transfer from ITU to MRI”
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The adult intubation card turned out to be quite popular - so a paediatric version of the safety card is being trialled, and is now hanging off our paeds transfer bags, ODPs & airway drs.
Let’s keep our brain free for the stuff which *needs* to be complicated.🧠
#MedTwitter
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I don’t really have an opinion on
#NHS
senior management- in my 12 yrs as a Dr, I’ve had minimal interaction.
Then you become a consultant & immerse into a 🌎 of management you knew nothing of.
Would it help mutual understanding to be gently exposed earlier?
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A short piece I wrote for FT on the post-Covid outlook for anaesthetists - enormous demand, few training jobs, and how our role may only be truly understood when our numbers have dwindled.
#NHS
@RCoANews
@Anaes_Trainees
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I see cases of pheochromocytoma more commonly than I see comprehensive school students on work experience in
#NHS
hospitals.
What are we doing wrong?
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1/2. I think every jnr doctor should do 3 months of ICU, & 3 months of palliative care. ICU to appreciate the reality of what they’re referring their patients for. Pall care to focus on the alternatives of comfort care,& listening to ppl’s wishes before they’re too sick to say.
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My intubation mini-checklist card, endorsed by, and using guidelines produced by
@dasairway
@RCoANews
@FICMNews
@ICS_updates
. Should be available to order soon through DAS website (or free giveaways at their November conference).
@WessexICS
Great idea from Sam Goodhand (Anaesthetic SpR in Wessex):
Credit card sized and designed to fix to the ICU on-call bleep.
The DAS ICS FICM RCoA Critically ill intubation CHECKLIST.
Fantastic Human Factors innovation!
Well done SAM!
Give-aways
@DASEdinburgh18
See you there!
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4. Keep talking to your patient and be open about the difficulties you’re experiencing. This will earn you more of their confidence than ploughing on silently as you get more flustered, which we’ve all done. Your patient will sense your secret frustration.
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10 RSI mini-checklist cards are in the post to every hospital in England, Scotland, Wales & NI, 5 each to airway lead and ICU matron.Get in touch with them if they don’t appear! We suggest attaching to on-call anaes/ICU/ODP/outreach bleep
@AAGBI
@dasairway
@ICS_updates
@RCoANews
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A quick letter for today’s Telegraph on the specialist training shambles, anaesthetist shortages & political priorities.
@Assoc_Anaes
@RCoANews
#NHS
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6. If you’ve asked for help and others can’t manage either, accept that some procedures are just extremely difficult and you need a different, pragmatic plan. This is right and normal, and not your failure as a professional. Document clearly & consider parallel options.
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5. Unless it’s absolutely urgent, if you’re struggling take a break from that situation and have a glass of water, stretch your legs etc before coming back to it. The downward spiral of performance and failure is real.
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Just preparing our intubation mini-checklist cards for
@WAMM_2019
, & a handful to be sent to every hospital nationwide in Nov! Using
@dasairway
guidelines & fixed to the ID card/bleep, these are already making our critically ill patients safer
#FOAMed
@ICS_updates
@Atul_Gawande
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Adult intubation checklist card using
@dasairway
guidelines - £0.34
Paediatric checklist card with drug & airway cheat sheet - £0.60
Over 2 years of never being without a checklist at an emergency -
Priceless
#patientsafety
#checklists
Orders:
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Anyone work on a unit that has banned patients being referred to as “Bed number X”?
Aside from being v. impersonal, it’s surely a safety trap considering how often patients are moved, and how little it demands you to engage 🧠. I seem alone in my hatred of it.
#patientsafety
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In many Australian hospitals, a patient’s ward consultant must be called,day or night, if they have a cardiac arrest/MET call.
Might this focus minds here,to have appropriate patient/CPR discussions, before their 3am deterioration?
#havetheconversation
#ordinarydying
#NHS
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@mevparekh
I once texted a consultant & foundation program director to say I was running slightly late for our meeting. I then inadvertently also sent a picture of an Alsatian in a fish tank. Awkward
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After great feedback from trialling our paediatric RSI & safety cards, we’ll soon be able to provide cards to trusts.
Now with a space for your regional retrieval team’s QR code, to rapidly access local guidelines / support.
#intubationchecklistcard
#medtwitter
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C-section overnight.I note the husband has the same trainers as me.
My trainers are missing from maternity changing room this morning.
I investigate.
HCA:“Nobody claimed them after, so I binned them”.
Hope everyone else’s weekend started well. 👟🗑
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The greatest dilemma facing doctors today - the guilt of recycling just under a tonne of largely unread BMJ bulletins, or the comfort of keeping them safely boxed for another year, but faced with the judgement of those closest to you. They have made us hoarders.
#juniordoctors
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@DavidJuurlink
Is this a post on the power of placebo as the label truly seems to say 000mg/ml?
Or a worthy tribute to ketamine with a dangerously awful label?
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Opportunity to order more intubation checklist cards (supported by and using guideline from
@dasairway
)
Please email checklistcard
@outlook
.com with your name, trust address, and how many you want.
Please see more details (inc price) in tweet 2...
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You only need to read this thread -various doctors belittling an eminent scientist’s fears of
#COVID19
, because their own specialty has *far* more stressful moments - to realise why the public can find healthcare professionals arrogant and tunnel-visioned
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The “Crash Trolley” - the stalwart of every hospital emergency . Ergonomic, organised, all-in-one…
Or are they hiding in plain sight in the hunt for better human factors?!
Would a multi-modular, A/B/C break-apart unit be a no-brainer🧠 ?
A 🧵:
#MedTwitter
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Every month or two, someone gets in touch to feed back on how the paediatric checklist card helped. Brilliant to get this:
“In resus to tube a fitting child. Asked for checklist. Was met with blank faces and so just reached for my lanyard and there it was!”
#patientsafety
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Following much demand, you can now order the Sussex Paediatric Checklist cards for your dept!
It features an intubation checklist, drug & equipment cheat-sheet, and you can stick on your retrieval team’s QR code for local guidelines.
Please see thread for instructions...
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Why do we never, ever see EMLA cream on patients having repeated arterial stabs? We marinade kids & needlephobics in local gel for a single cannula, but our big, uncomplaining builder with COPD might endure 3 or 4 stabs on day 1. Might it transform their experience? 🐣
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Close your eyes & imagine cooking in your kitchen or performing a driving task in your car. You instinctively know where everything is.
Now imagine a resus / ICU bay / anaesthetic room you frequently work in. Can you visualise prepping for a procedure?
Fiver says you can’t.
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Here’s the global intubation checklist card (GAS Card) in use with my co-developer
@lofoporp
,in Zambia.
The cards are being embedded within
@SAFE_courses
in low & middle income countries,to help make emergency anaesthesia safer.
@wfsaorg
@Assoc_Anaes
@dasairway
@KidsOperating
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Never managed a severe heat stroke in 2 years in Australia.
Then in one unusually hot afternoon in North London, we received one fit young builder who died, and another who needed intubating. We’re not prepared for truly hot weather.
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They really are superb aide memoirs which an ODP can crack though in 30 seconds to check your thinking.
Far from being a threat to your own excellence, the skill & intrinsic knowledge to consider and eliminate each possibility is enormous. 5/
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@DrLongissimus
When they pull shit like that, I say “It’s not an I Spy book mate, get learning some pattern recognition”. It’s very 1990 but it seems to go down well.
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Calling all UK anaesthetic / ICU doctors, Outreach & ICU nurses, and ODPs....have the RSI checklist cards made it to your bleeps?
If not, please ask your airway lead or ICU matron for them!
Please RT
@dastrainees
@dasairway
@FICMNews
10 RSI mini-checklist cards are in the post to every hospital in England, Scotland, Wales & NI, 5 each to airway lead and ICU matron.Get in touch with them if they don’t appear! We suggest attaching to on-call anaes/ICU/ODP/outreach bleep
@AAGBI
@dasairway
@ICS_updates
@RCoANews
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The new Global Anaesthetic Safety(GAS) Card.I’ve worked with Dr Mack Kalenga
@lofoporp
& his dept at UTH Lusaka,Zambia to trial this adult&paediatric safety card for global use.
We’ll soon expand this,trialling via
@SAFE_courses
in low/middle income countries.🌍1/3
#MedTwitter
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@MonicaMalta7
@Raj_Collage
I’m not sure she’s tweeted anything unethical. Especially given your own position as a role model, maybe a DM to Rasha with your valid concerns about social media and employment would have been kinder than a public admonishment.
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Great to be in this month’s
@dasairway
ezine. I write about the journey of the intubation checklist card, from homemade sticker to well-established safety tool.
“Shout out” (🤨) in the piece to
@BSUHgas
and
@DCHFT
for their support.
#patientsafety
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Recently we had a reminder of the QRH at our audit day - we all agreed they were great but weren’t always utilised.
Then last week we had a hypoxic patient - we took the logical steps then ran through the hypoxia page. Great to be reassured we’d not overlooked anything. 👍 4/
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@JamieVassallo
Hey Jamie, hope you’re well mate.
I don’t have a PDF but you could screenshot this. The card embodies the DAS guidelines for intubation of critically ill adults, so you could also get PDF of those. The card aims to ensure you’ve always got the checklist on your person
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Mum & baby all fine, but it shook me up for a while. I knew I’d checked the ET too late, but what if I hadn’t when I did?
I didn’t know about the QRH at the time, but was aware a more objective list of troubleshoots might’ve loosened my fatigue & fixation on the data I had. 3/
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Touched to see a district nurse, in uniform, at my brilliant Grandad’s funeral. Not only showing how admired he was by so many people, but the incredible dedication of our nursing colleagues. Seeing his recent care as an outsider reminds me how proud we should be of the
#NHS
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Very proud to have received this award from such a fantastic organisation - thank you
@ICS_updates
.
This project could never have expanded without the consultant support & enthusiasm our specialty is renowned for. To name a few
@AndyHiggsGAA
@DCHFT
@BSUHgas
@ESHTNHS
@dasairway
⭐
#ICSAwards2020
| Innovation Award ⭐
Recognising new innovative ideas, techniques or equipment which have led to significant improvements in patient care
🏆 The winner is
@SamGoodhand
from Kent Surrey Sussex School of Anaesthesia
Congratulations!
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There are now over 8000 of our intubation checklist cards in use across the World.
You can order a batch for your department, to help overcome checklist availability issues & maximise emergency airway safety.
Please read thread for details!
@ICS_updates
@dasairway
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Considered a blocked tube -dismissed. Treated bronchospasm, called a colleague for fresh 👀 . Considered tube change-thought it unwise. Finally, luckily not too late, I looked with the scope to find a badly kinked ET tube in the throat. Somehow O2 sats held, ET changed👌 ✅ 2/
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@BellaRoscetti
Legendary surgeon Prof Harold Ellis once said I “should be a psychiatrist” while watching me saw through a dissection room cadaver’s sternum, with a wry smirk.
I’m not sure he meant it the same way.
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@frantait85
“We all know each other”….
“Doctor, can I have your name for Theatreman log please?”
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@VirtueOfNothing
@theRCN
The
@theRCN
made an absolute meal of their campaign, lost their members’ confidence by forgetting when their mandate expired, then capitulated when a dreadful offer was made.
Yet they find some fire in their belly when an allied profession has a pay offer made? Staggering.
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Checklist card delivery day here...🚚
Important milestones this month - paediatric safety cards now order-able with the established
@dasairway
based card. And 10,000 adult checklist cards now in use worldwide.
Let’s free our brains up for the clever stuff 🧠
#MedTwitter
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@IsMiseStiofan
No 🥩 with them.
They’re a fantastic asset, the ones I work with are great. But I don’t think doctor-free cover on ICU is a good idea - simple as that.
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Calling docs of all levels in all specialties
You’re seeing a patient on an unfamiliar hospital ward. Which items do you spend most time looking for & cause you the most wasted time and / or frustration 🕰️ 🤬?
Starter for ten:
History sheets
Gauze
Gas syringe
#humanfactors
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@TurtonsOther
“I’ve had a look at him and he’s sat up cheerfully eating his breakfast”.
Code for “I’ve never met this chap before, I know nothing of him. But he’s still alive, and hopefully that was the anxiety you wanted to allay by calling at 8.05”
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Nobody knows where the next variant will be cultivated, but my money’s on an NHS mouse mat....
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@robhezzCCOT
Or at all, regardless of ceiling of treatment. Why do you need pO2 when you have a sats probe? Why do you need PaCO2 when you have a VBG or (heavens forbid) bedside judgement.
There’s a role for them but I reckon 80% on wards are part of numbers-based doctor self-treatment.
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I’m ordering a new batch of paediatric airway checklist cards - see pics for details.
Dosing & equipment sizing aids included, great for docs/nurses/ODPs who manage sick kids.
Please RT - Elon’s algorithm doesn’t favour human factors innovation any more! 🙏
#MedTwitter
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Not long til a [hopefully] game-changing addition to the checklist card family….
For the cost of 1 disposable VL blade, you can still equip 30 of your team with the original adult cards (using
@dasairway
SOPs) & overcome checklist availability issues. See below 👇 for details.
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There’s a wider context to West Hampstead’s packed market today.
It’s very clear that people think bad shit only happens to somebody else.
And that’s why nobody wants to properly fund the NHS & social care.
Still, we all like organic chutneys.
#WestHampstead
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You have severe pneumonia. Average BMI & known Gr1 intubation. Do you want to be intubated by:
A: Experienced A&E doc. Intubates twice/month. V.protocolised practice - fent/ketamine/roc,123.
B: General anaesthetist. Uses cautious propofol with “chasers” for BP.
#MedTwitter
A: A&E doctor
919
B: General anaesthetist
2170
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Amid the chaos & compromise, the intubation safety cards are a reassuring constant.
A cleanable, double-sided, always-available tool to keep both big & little patients safe.
Info on how to order cards in the
@dasairway
e-zine spread here...
#MedTwitter
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Rolling out the GAS checklist card in low & middle income countries - article with
@lofoporp
for The International Anaesthetist.
@SAFE_courses
@SaferSurgery
@KidsOperating
@MSF
@KrisTorgeson
@RCoANews
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Impressive Twitter 🗑️ 🔥 over a lanyard this week.
Here’s something uncontroversial - hang one of these adult, paediatric or global checklist cards on your
#lanyard
& you’ll feel better prepared & your patients will be safer (whether you’re a dr, nurse, ODP or even AA 😎)
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Easy wins (1/2)
1.Stop talking during WHO checklist
2.Stop referring to patients as “Bed [number x]” (& it’s weird and dehumanising)
3.Put sicker ward patients in plain site of nursing station
4.E-obs that trigger critical outreach at a given EWS
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The intubation checklist card overcomes cultural unavailability (staff feeling unable to ask for one/no consensus on one between depts), not just physical unavailability.
To help this, I’m doing an order run for as few as 8 cards.
1/2
#MedTwitter
#patientsafety
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Proud to net a runner-up award at
#TEAC2022
, with the support team in attendance 😊. Lovely day at the Amex, & great hospitality by
@OfficialBHAFC
.
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I normally love hearing the volunteer pianist or quartet playing in the hospital corridor.
Today it just feels a bit like the Titanic.
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@D_Rodders
At Anaesthetic Updates at the
@RCOAnews
recently, there was a talk titled “workforce planning”.
It was a talk solely about AAs, exclusively. I think that was quite telling of the future vision.
I think more explicit transparency needed, though.
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@timmartindale
It takes supreme confidence to offer up your services as a trainer of failure 😂
I was genuinely reflecting earlier on how good the training was that I did get from you, at quite a pivotal time. Good days!
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It’s almost 5 years since the intubation checklist card went nationwide, and there are now 16,000 adult, paediatric & global cards in use 🌎!
Now’s a good time to order a batch for August your team of Docs / acute nurses / ODPs. Details in 🧵
#patientsafety
#humanfactors
Crash intubation in A&E the other night. Urgent ++, so we observe a shortened checklist.
20 seconds later we’re ready to RSI, having identified suction not switched on.
If you think you don’t have time to do the checklist, the more you need to do it.
#patientsafety
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Had an interesting chat with a student paramedic who joined me to practise airway skills...
Paramedics, how have you found placements in theatre?
Have you felt welcomed by anaesthetists & had opportunities to intubate / insert LMAs with supervision?
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@MonicaMalta7
@Raj_Collage
Not to mention also, it was probably for a routine knee operation and not a critically ill patient. Which I suspect she didn’t say, for confidentiality....
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@Louisdebernard
Out of hours usually an SAS doc or fellow.
Let me be clear - the ACCPs I work with are fantastic. But I worry we’re witnessing a trajectory here, and who knows where we are on it?
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Can’t wait for the cringeworthy thread by a gastroenterology MD with their heroics on this ✈️.
“Captain ordered to descend for gut distension. Loperamide ready to go, Dioralyte STAT (straw given by Paula 👏) . Roles allocated - James MD already blue-rolling carpet”.
"Diarrhea Plane " - Footage of the cabin from the Delta plane headed for Barcelona that had to be diverted to Atlanta due to a passenger having diarrhea all over the plane.
#Biohazard
#plane
#aviation
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@Medic_Russell
@willtube4food
This. It feels like it’s unfashionable now to tweet about good / inspiring stuff. I really wonder about the effect it has on new docs and med students who read it. I was even thinking of compiling a list of inspirational & interesting docs / paramedics / HCWs as an antidote.
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O dear...my bottle of Lidl red is ageing better than this RCOA bulletin 😕
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Getting a paediatric emergency drug calculation on NHS sites seems extremely difficult.
Give it a try for a specific weight and see how long it takes.
NHS tech-based resources for emergencies shouldn’t slow you down or introduce new risk.
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