Hot cheese: a processed Swiss cheese model

James Reason’s classic Swiss cheese model is a vivid and memorable way to visualise how patient harm happens only when all system defences fail. Although Reason’s model has been criticised for its simplicity and static portrait of complex systems, its use has been growing, largely because of the direct clarity of its simple and memorable metaphor. A more general, more flexible and equally memorable model of accident causation in complex systems is needed. We present the hot cheese model, which is more realistic, particularly in portraying defence layers as

Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants

Objective: To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently  prepared to deliver generalist palliative care, with a view to informing developments in  undergraduate and postgraduate medical education.

Methods: Questionnaires were sent to FY1 doctors and to supervising consultants. Semi-structured interviews were conducted with five FY1 doctors.

Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

Background: Our Trust developed a clinical guideline to improve the prescribing and use of intravenous (IV) fluids based on the British consensus guidelines on IV fluid therapy for adult surgical patients. We audited the effect of targeted interventions to improve performance against this guideline.