A generation of Doctors unable to look after their patients?

Dr Anthony James is a Consultant Physician at Princess of Wales Hospital. 

There have been many changes in recent years. The patients are older with more frailty, multiple comorbidities and a mixture of social and medical issues. These patients are often described as ‘complex’, making them sound as if they are something special. The reality is that they are now the norm and everybody should be able to deal with the norm. These problems are recognised by Royal College of Physicians in Hospitals on the Edge? The time for action (2012);

‘All hospital inpatients deserve to receive safe, high-quality, sustainable care centered around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.’

‘Look out’ – assessing a patient’s vision for falls prevention, what should it look like?

Dr Kawa Amin represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). He is a Consultant Geriatrician, Consultant lead for falls service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust.

As part of my role on the NAIF advisory group I have been involved in the development of a new bedside vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

Being acutely unwell is and in a different environment, is a stressful experience.  Even with reassuring care from clinical teams treating them, older people often need extra support in a ward environment.  Can you imagine how frightening such an experience might be for a patient with visual impairment?  It’s perhaps no wonder that poor vision is a risk for delirium.  

Developing new guidance on how to measure lying and standing blood pressure- harder than you think!

Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient  Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1  

As the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.

One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP.

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

How good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data.

Physician-assisted dying: the BGS, the RCP, and the law

David Oliver is the current President of the BGS, a visiting Fellow at the Kings Fund, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust.

In the wake of Lord Falconer’s Bill to legalise assisted dying for terminally ill patients in restricted circumstances, the Royal College of Physicians of London recently surveyed its members, asking them a number of questions regarding a possible change in the law.

As the biggest speciality within the college, BGS members were among those who responded. It’s the nature of our work as geriatricians that (alongside palliative care and oncology specialists) we spend a greater proportion of our working lives than most physicians dealing with planning, care and support towards the end of life, and supporting patients and their relatives through the final phase of their illness. So we have a key stake and keen interest in this question.

Care centred around the patient: discontinuing the lack of continuity of care

Dr Mark Temple is the Future Hospital Officer at the Royal College of Physicians (RCP), overseeing the implementation of the Future Hospital Programme. The aim of the programme is to take the recommendations of the Future Hospital Commission report from page to clinical practice. The BGS is a partner supporting this programme.

While being interviewed by BBC Radio 5 Live, recently, I was rendered speechless by an angry carer whose elderly mother had moved wards five times during an acute admission, one of which included a transfer to a different hospital site. This is indefensible.

Lack of continuity of care is the number one concern amongst physicians. Patients and carers express this as a lack of ‘joined-up’ care, characterised by multiple ward moves and general bewilderment about ‘who is in charge?’

The RCP’s Future Hospital Commission report identified that the frail older patient with multiple co-morbidities is now the NHS’ ‘core business’. Sadly, examples of these patients’ needs not being met by consistent standards of care, including continuity of care, are all too readily available.

Joining forces: The Future Hospital Commission and Comprehensive Geriatric Assessment

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Honorary Secretary for the BGS. She tweets at @geri_baby 

The Future Hospital Commission (FHC) report, like so many other recent publications, acknowledges that our hospitals are not set up to meet the needs of the majority of people who use them. Where the FHC differs, however, is that it clearly states that routine incorporation of Comprehensive Geriatric Assessment (CGA) into the care of vulnerable older people is a way to address this. 

The future of hospitals is age-attuned

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

The Future Hospital Commission (FHC) has published its report and recommendations for ensuring that hospitals are designed around the needs of patients. The report recognises that older, frail and more complex patients with multiple long term conditions are the main patient group cared for in modern hospitals. It is critical that we meet the needs of these vulnerable individuals.

The FHC places welcome emphasis on the importance of Comprehensive Geriatric Assessment (CGA) but at the same time there are significant workforce implications for the expanded use of CGA in general hospitals.

Being The “Med Reg”

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. Here he reflects on a recent report from the Royal College of Physicians on the role of the Medical Registrar and how it it compares with his personal experience.

I was on call a few weeks ago and was shadowed by some keen medical students. It was a busy day and I spent most of the day in the resuscitation area of the Emergency Department. There was a handful of patients with COPD and type 2 respiratory failure requiring non-invasive ventilation, a couple of patients with pneumonias and severe sepsis, one who was peri-arrest with anterior T wave inversion and one with S1Q3T3 on their ECG who had a massive pulmonary embolism, and a young man with ischaemic extremities, pleuritic chest pain and a butterfly rash…

The students loved it. They found it fascinating, exciting, intimidating and then…

“I could never be the Med Reg”

It has always been so, yet increasingly trainees seem to be put off by acute specialties and the burden of the general medical take at a time when acute services are under increasing strain.

In this context, I was particularly interested in the recent publication by the Royal College of Physicians “The medical registrar. Empowering the unsung heroes of patient care.”