Re: Is it time for a new kind of hospital physician?
The rapid responses have eloquently underscored the key point of the editorial - it is urgently necessary that acute hospitals are transformed to become fit, safe and effective providers of acute care for older people. This means recognising frailty and multi-morbidity and the associated geriatric syndromes as core issues. Falls, delirium, loss of functional abilty etc are relatively preventable adverse events affecting patients in medical and surgical services.
Clinical trial evidence has shown that exceptional effort and innovation can make an impact but what's also needed is a re-orientation of practice at a "whole hospital" level. The principles need embedding in generic physician (and nurse) teaching and training, but progress can be made now by interspecialty collaboration in service delivery and clinical governance. Unfortunately traditional management structures and commissioning patterns are constraints to the transformations needed, so leadership from health professionals is vital.
Recent improvement in hip fracture care and outcomes as demonstrated by the National Hip Fracture Database (www.nhfd.org.uk) is an example of what can be achieved by geriatricians, orthopaedic surgeons, anaesthetists and specialist nurses working together towards shared standards, armed with reliable data. Surgery rates are growing fastest in the oldest patients and the BGS has now established an interspecialty interest group to address "The Proactive care of Older People undergoing Surgery (POPS)" Shortly we will be publishing quality standards for care of older people with urgent and emergency care needs "the Silver Book", in partnership with the College of Emergency Medicine and many other partners. Delivering these standards in practice in an age-attuned healthcare system is everybody's business but geriatricians, and enough of them, are vital to success.
Competing interests: Member of the RCP London Future Hospital Commission, and Co-chair of the National Hip Fracture Database