Alasdair Miller is a ST6 Specialist Registrar in Geriatric Medicine at Royal United Hospital, Bath.
Our day opened with Dr Chris Dyer and Dr Genevieve Robson describing the local work on Patient Flow and the successes of Bath’s Frailty Flying Squad! This multidisciplinary front door geriatrics team is now providing CGA in the RUH’s Emergency Department, leading to improvements in length of stay, ED wait time and improving rates of discharge to pre-admission home.
It was particularly interesting to hear about the positive impact of training senior staff via the Improving Patient Flow Programme. This led to the implementation of a weekly “Big Room” coached meeting at the RUH to provide an open, non-hierarchical forum to discuss quality improvement and innovation in services for frail patients. This project appears set to continue growing, with increasing engagement from community staff to break down the barriers between community and hospital care.
From frailty we moved on to Dr Lukuman Gbadamoshi’s update on Thrombectomy for acute stroke – a powerful case was made for endovascular treatment of stroke caused by proximal large vessel occlusions. In a series of eloquently described cases the logistical challenges became clear – getting the right patients from across the region to the specialist service in North Bristol in a timely fashion is not straightforward. Furthermore, the relative scarcity of interventional neuroradiologists able to perform these skilled procedures prevents these life-saving and life-changing treatments being offered outside office hours, an issue which the Southwest has in common with many other regions.
After a brief break for recaffeination, Dr Tom Welsh, a geriatrician with a special interest in dementia working at the RUH and RICE centre, gave us his tips and tricks in diagnosing different forms of dementia. Following this theme, Dr Richard Graham, a radiologist with an interest in functional imaging in dementia, took us through the use of advanced imaging techniques such as PET and DAT scans, offering insights into when such scans are useful, and explaining the use of amyloid tracers and tau imaging in dementia research.
Post lunch, our programme moved on to platform presentations from two trainees: Dr Frankie Parry on her experiences as a Frailty Fellow delivering CGA at the BRI, and Dr Fran Moore on her project on improving Bone Health in patients on an acute stroke unit. The afternoon continued with a great talk from Dr Andy Stone on Cerebral Amyloid Angiopathy, with some really helpful pointers on how to spot this unusual condition and his approach to treatment, with emphasis on minimising medications such as anticoagulants, antiplatelets and statins which can increase the likelihood of further haemorrhage.
Finally, our day was brought to a close with a fascinating talk by Professor Julian Hughes on Palliative Care in Dementia – covering recommendations from the White Paper into Palliative Care in Dementia, emphasizing the huge importance of advance care planning and making the case for more involvement of both geriatricians and old age psychiatrists in the care of nursing home patients with dementia.
This meeting was packed with passionate speakers and varied topics- from frailty to thrombectomy, and from PET to palliative care! Perhaps more than anything as the day ended I was left feeling that we are lucky as a healthcare community to have such enthusiasm for Geriatric Medicine evident in the region. Regular BGS regional meetings are a fantastic way to learn, get ideas and hopefully instill an interest in Geriatric Medicine in those considering their next career move – keep your eyes open for the next one!