How we built a Geriatric Service in the ‘largest hospital in Europe’

Caroline Whitton is a Geriatrician working in NHS Greater Glasgow and Clyde currently based in the Victoria Infirmary, Glasgow which is soon to be subsumed into the South Glasgow University Hospital. She has several educational roles which include Foundation Programme Director, Consortium Lead for NHS Education Scotland and Associate Director of Medical Education for NHS Greater Glasgow and Clyde.

For me, the adventure began when I was asked to deputise for my Clinical Director at a meeting to discuss junior doctor staffing of a new admissions unit. The meeting was hosted by the medical directorate, and I was the lone geriatric voice amongst a cast of many. From that meeting began a process that has, for the time being, taken over my professional life! Do I regret my initial impulse to go along? No – because it initiated a journey which has enabled me to be involved with the design of a completely new service. It has made it possible for me to influence the way in which I provide care to my patients and deliver training to my junior colleagues.

Right Assessment, Right Time

This blog is part of a semi-regular series on team working: if you work as part of a “dream team” and want to blog about it, please let us know! Email communications@bgs.org.uk and we’ll be happy to help.

This blog comes from Angela Moore, an Older People’s Specialist Nurse at Hinchingbrooke Hospital.

Our team has started small but we are aiming high: high standards, high levels of satisfaction, and high levels of engagement. We started 8 months ago when my colleague Caroline and I were employed by Hinchingbrooke Hospital to meet our frailty CQUIN. How things have grown in such a short time! We’ve had some amazing support including that of our director of nursing Deirdre Fowler, our orthogeriatric consultant Sally Bashford and our divisional lead. I’m sure we’ve driven them all a little insane with our boundless enthusiasm!

We are both passionate about providing high quality patient centred care; we believe our patients are at the heart of everything we do and deserve the best care we can provide. In the few months that we have been in post we have implemented the use of Comprehensive Geriatric Assessment (CGA), and raised awareness of its importance with both medical and nursing staff. We have been able to implement training programmes for new staff and support information governance training.

Through raising awareness of CGA we’ve improved patient experience and communication. We have been able to develop links with community matrons and Community MDT coordinators; this has improved the communication between primary and secondary care. Our plans are to improve even further on this by arranging hospital community interface MDT meetings. I’m sure this will enable us to support further training for all nurses, giving them some insight into how we can better improve collaborative working with community teams.

We’ve had fun recently raising awareness within the hospital of our dementia café, which is supported by volunteers and the Rotary Club. Poor turnout had left the Rotary Club feeling rather deflated, so we were asked what we could do to support them: we had a fab reminiscence day at the front of hospital, donning period nursing costumes and displaying memorabilia.

Our next steps are aiming higher: we hope to see all patients over 75 admitted to our hospital at point of contact, as suggested by the Silver Book guidance and the BGS. We’ve been supported with the purchase of a geriatric simulation suit which has proved to be a valuable training resource.

I love the variety and challenges that this role brings But most of all I enjoy the pleasure of training and education to improve awareness of the needs of older people. It is important that we act as patient advocates to raise awareness of the vulnerability of this patient group, and reduce the risk of hospital acquired harm. It is important that we remember that many of this age group have lived enriched lives: they deserve respect and dignity. 

Frailsafe – “All share, all learn”

Zoe Wyrko is the BGS Director of Workforce Planning; she’s previously blogged about Frailsafe, the British Geriatrics Society project funded by the Health Foundation to improve the acute care of older people being admitted to hospital, and tweets @geri_baby.

Frailsafe is starting to happen! It’s been an exciting (and exhausting) week for the team, with the first learning session taking place over three days in Sheffield.

In addition to multidisciplinary teams from the 12 sites chosen to take the project forward, we have had stakeholder involvement with Tom Gentry from AgeUK, patient involvement with Olive and Ron who attended a couple of sessions on day 2, but more importantly an overwhelming sense of enthusiasm to make the Frailsafe checklist for admissions work. We’ve been immortalised in art by our illustrator, and we’ve been interviewed and filmed for a Frailsafe promotional video.

The learning environment has been truly multidisciplinary, (doctors, nurses, physiotherapists, OTs, pharmacists and hospital managers) and the team from Sheffield Microsystems Coaching Academy have been sharing their extensive skills and knowledge with us. Some of the concepts have been totally new, but in other areas I’ve been left thinking ‘Why on earth haven’t we been doing that already? It seems so logical.’ And I’m not the only one: another colleague is relieved because he now understands why his managers keep trying to make him do things with Post-it notes.

An element of cynicism is likely when doctors are presented with timetables which include a ‘paper aeroplane factory’ and ‘the marshmallow challenge,’ but with hindsight it is impossible to argue with the practical illustrations delivered by these training sessions. Why are we as clinicians so reluctant to adopt proven messages and systems learned by industry to improve quality and consistency? Even the ice-breaker – asking delegates to arrange themselves in a line according to distance travelled – was a lesson in systems and complexity. We have learnt about the psychology of improvement, how to understand and appreciate systems, and how even at a relatively basic level of knowledge we can improve the patient journey while bringing colleagues along with us.

We’ve also been able to speak about how Frailsafe got to where it is now; the reasoning behind the questions we chose for the checklist, and (probably more importantly) why certain areas are not included. The unveiling of Frailsafe version 8 was a big moment, and emphasised  the importance of having professional designers involved in a project such as this!

The final day of the session was used for planning, with  each hospital team working with the microsystems coach who will be supporting them closely throughout the Frailsafe project. The sites each left with an individual plan of how they will start to use the checklist immediately, using the mantra of ‘start small, get bigger,’ but, more importantly, reassurance and understanding of what to do if success isn’t immediate.

Our continued thanks go to the Frailsafe partners, especially The Health Foundation who have made this work possible. Please look at our website, as many of the learning materials will be available there soon.

And if anyone is interested – Glasgow and Craigavon jointly won the paper aeroplane factory, and Sandwell were the ‘Mr Potato Head’ champions!

Be the Master of Your Own Destiny (with a little help from the BGS!)

Dr Sarah White

In my fourth year as a medical registrar I was feeling disheartened with gruelling on-calls, never ending night shifts and the constant daily battle and bureaucracy on the wards.  I decided to undertake a masters degree to re-awaken my passion for learning and medicine.  I opted to do the Gerontology Masters at King’s College, London.

 

Several friends had undertaken part time MSc’s and all had bemoaned the difficulty of balancing a full time job and on-call commitments with essay writing, examinations and lengthy dissertations.  As one part-time masters friend put it, she did “just enough to get by”, which greatly reduced her masters experience.  I wanted to the get the most out of my masters and give it my full attention hence decided to do it full time over one year.  However, the major downside of being a full time student is lack of income!  Masters fees are expensive (mine cost £6,500), regular travel to university from outside London was not cheap; printing and photocopying costs were an unexpected and substantial outgoing; not to mention the ever increasing cost of living.  Needless to say I relied on personal savings, sporadic locum shifts and a very understanding fiancé to support me through the year.

Geriatric Medicine and the burden of common sense.

Prof Kenneth Rockwood is Director of Geriatric Medicine Research at Dalhousie University, Canada and serves on the International Advisory Panel of Age and Ageing journal. 

I’ve been teaching geriatric medicine for about 25 years. During that time, my attitude towards the common sense of geriatric medicine has changed. At first, I saw it as a great blessing: it was easy to let people know what they needed to do. Then I began to see it as a challenge: an audience could sit through a diverting 40 minutes, but in the end not be persuaded that they have learned anything. “Nothing to that – it’s all common sense”. Now I see the common sense of what we do as a foe, and one that we should conquer.

Shape of Training Report – more clarity needed before the opportunities can be realised

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. She tweets at @geri_baby

A joint position statement has been released by the Royal Colleges of Physicians (Edinburgh, Glasgow and London), and JRCPTB on the Shape of Training report (ShOT). Since the publication of Professor Greenaway’s report late last year there has been a considerable amount of concern that the recommendations contained within would lead to the decimation of postgraduate medical training in the UK, resulting in a sub-consultant level and inadequately trained doctors. I previously blogged about this in November 2013.

A perspective of Geriatrics: The Foundation Years

Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician.

Geriatrics was a difficult placement for me as a student. The way we learn in medical school makes cardiology and gastroenterology rotations an easy place to learn what we need to learn. The problems are fairly logical and the solutions are also fairly logical. My simple medical student brain could comprehend it. I didn’t quite cut it in Elderly Medicine. The patients and their issues (both medical and non-medical) are often complex, with multiple interactions and facets, requiring “illogical” treatments and strategies that don’t always follow rules or make sense. Without a pretty astounding understanding of physiology, pathology, ageing, sociology and public policy, it will all go over your head. What I saw was a bunch of crumbly, demented old people who didn’t seem to get better. Shame on me.

Why I Chose Geriatric Nursing as My Specialty

BGS blog followers may be interested in this article Why I Chose Geriatric Nursing as My Specialty from the Hartford Institute for Geriatric Nursing blog.

I never considered specializing in geriatric nursing before my academic career at New York University mainly because I have had limited interactions with the elderly.  My maternal grandparents died while trying to escape the Vietnam War and my paternal grandparents lived out in the Midwest so I rarely saw them.  It wasn’t until last summer that I was able to connect to geriatrics on a more personal level.

At the tail end of summer 2013, I volunteered with the medical relief organization, Floating Doctors, which provides healthcare and medical treatment to isolated coastal communities in Panama.   They also worked locally with a live-in geriatric facility, the asilo, by providing regular visits to conduct check-ups and physical assessments, administer medications as well as offer companionship to the residents.  For the most part, the residents were in good health and mentally present.  However, open sores, scabies, dementia, and debilitation were common afflictions.

The full article can be read on the Hartford Institute for Geriatric Nursing blog.

Generation Geriatrician?

Felicity Jones is a final year medical student at King’s College London and current Junior Members Representative for the BGS: representing Junior Doctors and Medical Students on the Trainees Council. She tweets personally at @faejones, and for BGS at @younggeris.

Caring for an ageing population is a major challenge of our time. Across the world, societies are ageing, with wide-ranging impacts. Many overlook the huge contributions the over-65s make to our labour workforce, running the third sector, and as carers for friends and relatives. It’s easy for these contributions to be ignored in a narrative which at a societal level tends to focus the challenges of providing a comprehensive health and social care to an ever-increasing proportion of our society.   

Simulation can help us get the basics of care right

Michael Alcorn is a Geriatric and General (Internal) Medicine Specialty Registrar at the Southern General Hospital, Glasgow and Honorary Clinical Teacher at the University of Glasgow Medical School. You can view the poster of Dr Alcorn and team at this week’s BGS Scientific Conference, at exhibition space 66.

In common with other UK doctors in training, I have been taught in many different environments by many different teachers with differing understandings of what it means to teach and to be taught.