Asan Akpan is a community geriatrician in Merseyside and research fellow for the Older Persons Working Group at the International Consortium for Health Outcomes Measurement. In this blog, he introduces ICHOM’s work and calls for your involvement.
There’s a growing consensus around how to provide optimal care for people with multiple conditions: this involves comprehensive, continuous care and oversight. Structures and processes should focus on the person receiving care, allowing them to determine their own preferred outcomes.
Anywhere you look, a common theme is variation in care outcomes within and between healthcare organisations. Traditionally, outcome measures tend to be designed for episodic care, are focused on processes rather than people, and usually aren’t standardised. When different parts of the same healthcare organisation (or different organisations) want to compare their performance, interpretation of the outcomes is unreliable. This often impedes the important work of improving care across departments and organisations.
Sally Roberts is Lead Nurse (Quality and Partnerships) at Walsall Clinical Commissioning Group. Here she describes work undertaken jointly by Walsall CCG and Walsall Healthcare NHS Trust, which has led to the implementation of a new integrated health care model within care homes.
Walsall’s new model of care has enabled the whole care home sector to raise standards, measurably improve outcomes for residents in care homes and reduce unnecessary hospital admissions.
Our work commenced in earnest with the nursing home sector over three years ago, at a time when there was increasing suspension of admissions, often due to poor quality and patient safety issues; these reduced market capacity and choice for people, and created financial uncertainty for some smaller independent homes. Care home managers reported in several forum meetings that they were struggling with poor staff retention, disrupting stability of care, leading to ineffective planning and viability of the home in the long term. In addition, the lack of proactive management of patients resulted in a high number of avoidable hospital admissions.
Sarah Blayney is a Clinical Fellow in the Calgary Stroke Program at Foothills Hospital, University of Calgary. She received a BGS SpR Travel Grant to help fund her fellowship.
As the branch flicked back and caught me full in the face, I saw another coming from the side just in time to throw my weight left and precariously low over the horse’s neck. We had left the trail some time ago after encountering more fallen trees after last week’s snowstorm; the temperatures had soared to the high twenties again but this far out into the mountains there was no one around to clear the trail. Narrowly avoiding my leg being crushed against a tree as we forged our own path through the undergrowth, I wondered quite what I’d let myself in for this weekend. The initial natural obstacles encountered on the lower level trails were nothing in comparison to those up here, and the gradient was punishing for both us and the horses.
Eventually we broke the tree line and took in a spectacular view of the valley below. Any breath left was soon gone after struggling up the last section: so steep here that we were out of the saddles and down onto our feet. After three hours of hard riding my legs were
in no shape to clamber up a rocky outcrop while trying to persuade several hundred pounds of horseflesh behind me to wait his turn, but a few minutes later I sank gratefully onto the coarse grass at the top. Once up there our horizon broadened further, taking
in the mountain ranges to the north and west. Far in the distance, a hunter’s rifle fired periodically and the echo bounced around the mountains for several seconds each time. It was the hardest and most exhilarating riding I’d ever done, and the view from the
top was outstanding.
Dr Shane O’Hanlon is a consultant geriatrician in Reading, and edits the BGS Blog; he tweets at @drohanlon
It seems like ages since the last quality textbook in geriatrics came out, so it is great to see this new addition to the popular “At A Glance” series. I’m a huge fan of these books, with their concise 2 page summary-style chapters that are ideal for quick reference. As a medical student they were perfect for revising, once you had read the main textbook: I spent many happy nights by candlelight with Pharm At a Glance, for example! Continue reading
Dr Ruth Peters works at the Imperial Clinical Trials Unit of Imperial College London. In this blog, she discusses her recent Age & Ageing paper on the links between air pollution and dementia.
A few years ago, a chance conversation with a cardiologist about the adverse impact of air pollution on cardiovascular health set me thinking would such exposure also be a risk factor for dementia?
James Fisher is an St6 in Geriatric Medicine at Health Education North East, and tweets at @drjimbofish
If you look after people with Parkinson’s Disease (PD) you’ll know that sometimes medication administration in hospital is sub-optimal. Things can get particularly challenging when patients are unable to take their usual tablets due to swallowing difficulties…
Missing PD medications is risky – not only will patients’ symptoms get worse, but abrupt withdrawal is associated with the rare, but potentially fatal, neuroleptic malignant syndrome.
Sarita Sochart is a consultant in Geriatric and Stroke medicine and Foundation Programme Director Health Education North West. Paul Baker is a geriatrician in Bolton and Deputy Postgraduate Dean, running the largest Foundation School in the country.
In this blog, based on their presentation at the BGS Spring Conference in Nottingham, they look at quality management in training, and trainees in difficulty.
Our presentation at the BGS conference this spring focused on the Trainee in Difficulty (TID). Evidence suggests that nationally 2-6% of all doctors may experience difficulties, sufficient to raise concern about their performance (Donaldson, 1994; NCAS, 2006).
For the purposes of the study the Northwestern Deanery has identified a TID as-
“Any trainee who has caused concern to his/her educational supervisor(s) about the ability to carry out their duties, which has required unusual measures”
This would mean anything outside the normal trainer-trainee processes where the Training Programme Director has been called upon to take or recommend action.”
(NW Deanery, 2013)
Trainees consistently experience high intensity of work, conflicting time demands and a progressive increase in professional responsibility. They are not supernumerary to service requirements and are aware of increasing expectations from the public and threat of litigation. However, with compulsory appraisals, assessments based around work and a culture of reflection, it is hoped that any TID will receive adequate and appropriate support.
(This is a corrected version of a blog published last week)
The July 2015 issue of Age and Ageing, the journal of the British Geriatrics Society is out now!
A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:
- Pharmacotherapy for type 2 diabetes
- Exercise regimens and bone health
- Balance training for in-patient rehabilitations
- What are frailty instruments for?
- Oestrogen replacement in postmenopausal women
The Editor’s View can be read here.
This issue’s free access papers are:
Katie Wells is a Senior Staff Nurse who has worked with older people for 20 years, and couldn’t think of a more satisfying specialty. Here she explains her work to highlight the benefits of Advance Care Planning, and how the death of her Nan made her want to change the role of ward-based nurses to help patients plan for the future.
With so many older people in their last years of life being admitted into acute hospitals, contact with hospital staff gives us a golden opportunity to develop good relationships with both patients and families. These relationships can allow us to make the time to initiate structured conversations surrounding the care and support patients wish to receive at their End of Life.
Enrique Soto Pérez-de-Celis and Ana Patricia Navarrete-Reyes work at the National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City. They tweet at @EnriqueSoto8 and @patsnavarrete
Although cancer can affect any person, regardless of their age, most people with cancer and most cancer survivors are older adults. Cancer is a disease of ageing, and in an ageing world, the role of the geriatrician in the management of the older adult with cancer is progressively becoming more and more relevant.