Person-centred care in a sustainable system

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds. She tweets @EileenBurns13 This blog originally appeared as part of Independent Age’s Doing Care Differently series. You can join the debate here.

We warmly welcome Independent Age’s new project, Doing care differently. Our members are passionate advocates for person-centred care. The role of geriatricians and specialist health care professionals starts with identifying the care and treatment that best suits an older person’s individual needs and wishes, and those of their families and carers.  Delays in access to social care, and also in intermediate care, for example, occupational and physio therapy, create unnecessary barriers to person centred care, leading to poorer health outcomes, an increased likelihood of presenting at A&E, and people having to stay on acute hospital wards for longer than necessary.  For older people with frailty the negative impact when this occurs is significant, and their health deteriorates with every additional day spent on an acute hospital ward. Continue reading

Seen the doctor on the Tele? Patient centred care needs to arrive for all, and none more urgent than for our older patients

Chris Subbe is a Consultant in Acute, Respiratory & Critical Care Medicine. He is a Service Improvement Fellow with the Health Foundation. He does research on patient safety at Bangor University. He tweets @csubbe

Unsurprisingly many of us have more medical needs as we get older. While some people manage to stay remarkably fit, for others it is getting more difficult to get around town or worse across country. The hike around an overflowing car park of an inner-city hospital does surprisingly little for mobility, and most people get little value from sitting in an outpatient waiting area to wait while their medical team is struggling with the application of queuing theory to healthcare.

A few years ago, when granddad was sent a follow-up appointment for his cardiac surgery several months after the operation, I was suspicious. I rang the secretary of the colleague who had done an amazing job on his heart to ask for the reason for the review. “An important part of quality assurance: we like to make sure that everything has gone well”. I explained that granddad had been in hospital, survived prolonged rehabilitation, and had already been followed up by an excellent local geriatrician and one of our brilliant cardiologists. He felt well. I suggested cancelling the appointment. Continue reading

The UK versus the Netherlands: Where would you want your grandmother to be looked after?

Barry Evans and Rachel Cowan are Specialty Trainees in Geriatric Medicine currently working as Clinical Fellows in Quality Improvement for Integrated Medicine in the East Midlands. They recently had the opportunity to undertake an exchange with Anouk Kabboord – Elderly Care Physician trainee in the Netherlands.

dutchAt a time when the European narrative is being rewritten, a common challenge facing all European nations is population ageing. Seeing and learning from different European countries’ responses to an ageing population is an invaluable opportunity to learn, discuss and share innovation between countries. As part of Health Education East Midlands’ Quality Improvement Fellowship, we were recently able to set up an exchange between the UK and the Netherlands for geriatricians in training to see and learn from each other’s working environments. Continue reading

Nursing documentation: Mind the gap?

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently a PhD student at The University of Nottingham. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Her blogs are her own opinion and do not represent the opinion of her employer or any other organisation. Co-author and supervisor, Dr. Sarah Goldberg, is an associate professor at The University of Nottingham. She tweets as @se_goldberg

Introduction

docsNew research out this week highlights the importance of nursing documentation for older patients in an acute hospital setting. The research ‘Gaps, Mishaps and Overlaps: Nursing Documentation, how Does it Affect Care?’ published in The Journal of Research in Nursing found that paperwork is time consuming to complete, takes nurses away from caring for patients, and can be counterproductive to delivering good quality nursing care to older people in hospital.

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Delivering high quality care for older people – are you sure you do?

Dr Christine McAlpine is a geriatrician and stroke physician in Glasgow, Chair of the British Geriatrics Society Scotland Council and the geriatric medicine speciality adviser to the Chief Medical Officer for Scotland. She chaired the multiprofessional group which produced the Healthcare Improvement Scotland Standards for the care of older people in hospital, published in 2015. She tweets at @CHRISTINE030214

bgs-principles-and-standards-page-001Health care for older people is core business for the NHS. Getting health care right for older people helps ensure we get it right for everyone.  Today the BGS publishes ‘Effective healthcare for older people; Principles and Standards‘, with a particular focus on those living with frailty.

The Principles and Standards are for the health care of older people in any setting –  not only for geriatric medicine wards, but for all of the health care departments older people may encounter – Emergency Medicine, ophthalmology, gynaecology etc – across the spectrum of care.

The concise 4-page paper includes core standards for care delivery and reminds us of the principles enshrined in human rights and equalities legislation. It outlines principles of health care for older people including effective, accessible and timely care; autonomy, choice and person centred care; and ensuring safety and dignity. Continue reading

Measuring up with ICHOM Part 2

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 (ICHOM).  In this follow up blog, he summarises ICHOM’s work on developing the first set of international health outcomes for older people. These outcomes included participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death.

ICHOMThe goal of the Older Person Working Group was to define a minimum set of outcomes for evaluating healthcare for older people. The group aimed to present a balanced and comprehensive review of measurement within a recommendation that was feasible to implement in routine clinical practice. An additional goal was to facilitate the creation of data that can be meaningfully compared for analysis, benchmarking and shared learning. Continue reading

Top 10 things we can do to improve care for older people right now

Mitsuko Nakajima (CMT1), Mary Ní Lochlainn (FY1), James Maguire (Registrar), Myuran Kaneshamoorthy (CT2), Jen Pigott (CT2), James Manger (CT2), Elizabeth Lonsdale-Eccles (CT2), Nivedika Theivendran (CT2), Laura Hill (CT2), Maevis Tan (CT2), Thomas Bell (ST3), Mark Lethby (CT2) & Alvin Shrestha (Clinical Fellow).

On February 6th-7th the BGS (British Geriatrics Society) Trainees Weekend took place in London. At one of the workshops, a group of us looked at how we can influence our colleagues to improve care for older people and also how we can conduct QI projects in non-geriatric settings. The workshop aimed to empower doctors who were not yet on a geriatric medicine training scheme to make a difference, especially where patients were unlikely to be seen by a geriatrician.

At the end of the workshop, the group put their heads together to come up with a Top 10 list, of things we can do to improve care for older people right now. Here are the results:

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My Patient With Parkinson’s Disease Can’t Swallow: Gulp…

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.

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The alchemy of teamwork: how do we transmute base practice into noble excellence?

5114199360_414703d434_oLiz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust.

Recent weeks have seen a huge challenge to healthcare teams across the country. The NHS has had to rise to the demands of increased numbers of people accessing services in all areas.

My suspicion is that the areas performing the best were the ones who already had strong teams in place, positive leadership and supportive group cohesion, adding the extra strength and resilience to a burgeoning population of patients.

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Reconfiguring clinical services: what’s the evidence?

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Dr Zoe Wyrko is a Consultant Geriatrician at University Hospital Birmingham and Current British Geriatrics Society Director of Workforce Planning. She tweets @geri_baby. Here she tells us about how the latest King’s Fund paper is relevant to geriatricians.

On Tuesday, the King’s Fund published a new paper called ‘The reconfiguration of clinical services – what is the evidence?’ in which they consider the drivers and evidence base behind the constant push for change which is endemic within the NHS. The authors discuss an analysis carried out by the National Clinical Assessment Team, commissioned by the National Institute for Health Research, and its implications for the National Health Service.

The document confirms what many of us working on the ground have probably suspected for some time: there is no evidence that reconfiguring hospital services on financial grounds alone produces a positive impact, but it does expose organisations to distraction together with clinical and financial risks. There is mixed evidence as to whether reconfiguration with the aim of improving quality is beneficial, with the most positive results found when such changes are carried out related to specialised services. This is clearly highly relevant to us as geriatricians, who are most likely to lead change for this reason.

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