Ward rounds – are they safe and effective for patients and doctors?

Dr Tarun Solanki is a Consultant Physician and Geriatrician at Taunton and Somerset NHS Foundation Trust.

Geriatricians are, in many hospitals, now responsible for looking after more than 50% of medical in-patients and are frequently required to look after outliers on non-medical wards. A recent article in the BMJ suggests that doctors’ way of working would not be accepted by businesses making decisions with far less impact and suggests that the old concept of the ward round is broken and needs to change[i].

Since we, as geriatricians are providing a substantial element of acute inpatient care, should we not be at the forefront of improving the ward round so that it is not only effective and safe for patients but also to ensure geriatricians do not suffer from undue work pressures and risk burn-out? Continue reading

Spring Speakers Series: Asthma in the older patient

Dominick Shaw is an Associate Professor and honorary clinician at the University of Nottingham and Nottingham University NHS Hospital Trust. He leads the commissioned severe asthma service and performs clinical studies in asthma. He will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Asthma still presents a major challenge to society. Although classically regarded as a disease of children and young adults, accumulating evidence suggests that late onset asthma carries a poorer prognosis. Moreover although the death rate from asthma has fallen over the last 10-15 years in people under 75, in those aged over 75 it has doubled. Consequently the overall mortality rate has not changed.

Asthma still causes significant social and financial problems for patients, with recurrent exacerbations needing oral steroids, hospital admissions, time off work and impact on families and carers. There is light at the end of the asthma tunnel however and asthma has advanced a long way from, in the words of a geriatrician colleague*, “one puff of the blue, two of the brown”. Continue reading

Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Nationally there is increasing recognition of the needs of frail older people in health systems, and  the UK’s rapidly ageing population will only increase in the years to come.

Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition –  geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group. Continue reading

Autumn Speakers Series: Under what circumstances, and in what ways, is a quality improvement collaborative likely to succeed in a care home setting?

Dr Reena Devi is a research fellow in the Division of Medical Sciences and Graduate Entry Medicine at the University of Nottingham. She is working on the PEACH (‘ProactivE heAlthcare for older people living in Care Homes) study, which is led by Dr Adam Gordon, and funded by the Dunhill Medical Trust. She will be speaking at the upcoming BGS Autumn Meeting in London. She tweets @_DrReenaDevi 

Improving healthcare services delivered to older people is high on the national agenda. Nationwide initiatives are currently focusing on this, for example, six of the Vanguard projects set up in response to the 5 year forward view are specifically devoted to delivering new models of healthcare into care homes. Smaller scale initiatives are also being carried out in local settings, such as the PEACH project.

The PEACH project is using improvement science to bridge the gap between what we know and what we do in terms of the healthcare services delivered to care homes in South Nottinghamshire. The project is working with 4 clinical commissioning groups and their associated healthcare and care home providers, and is focusing on bringing healthcare services closer in-line with the Comprehensive Geriatric Assessment (CGA) model of care. Continue reading

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.

Continue reading

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