Experience of using a regional network of hospitals in the care of older inpatients with COVID-19 in spring 2020.

Introduction: Frail, older patients with COVID-19 have an increased risk of hospital admission and death. Methods: We studied a regional model of care used for older patients with COVID-19 in spring 2020 across three settings: an acute teaching hospital, a district general hospital and a temporary emergency hospital. We also studied demographic and outcome data for these patients. Results: Increasing bed capacity in non-acute sites freed up beds in acute hospitals. Strict admission criteria and multidisciplinary team involvement allowed for the safe delivery of care in step-down sites. Conclusion: This model of care allowed for patient flow out of acute sites following the acute stage of their illness allowing for an increase in bed capacity while providing a safe setting for ongoing management.

Nutrition, older people and the end of life.

Older patients are at increased risk of malnutrition, resulting in higher mortality and morbidity. It is important to address nutritional need early in order to prevent or mitigate these adverse outcomes. Decisions about nutrition and hydration for older people presenting with acute illness or evolving multiple long-term conditions present great difficulty to all involved. Clinicians are more likely to encounter such situations as the population of older people with frailty syndromes expands. The clinical evidence base to guide such decisions is sparse and largely unhelpful. Clinicians must recognise their role in these difficult decisions. In addition to familiarity with the clinical evidence base, they must be fully informed of the legal, professional and moral context of the decisions with which they are faced. Responsible clinicians have a professional duty to elicit, understand and weigh the views of their patient, and where necessary their representatives. This can only be undertaken through a process of facilitated patient choice utilising the available legal and professional decision-making frameworks. Any decision relating to clinically assisted nutrition and/or hydration in a frail older person who is considered to be nearing the end of their life must also include explicit consideration of the needs of that individual for formalised palliative care.

Competency mapping in quality management of foundation training.

Competency-based curricula focus on outcomes in terms of application of knowledge and acquisition of competencies. The aim of this exercise was to analyse posts and programmes for potential training outcomes. A mapping process against the UK foundation curriculum was designed. Data were gathered from foundation directors using red/amber/green judgements for each post. After submission no correspondence was needed on any programme about educational arrangements, suggesting the process had a significant formative effect as well as assessing outcomes. Certain competencies were problematic across the majority of host providers, allowing programme directors to ensure deficiencies are compensated by planned teaching or simulation training. Widespread difficulty in achieving these competencies raises the question of whether they should be included within the national curricula. Development of competency-based training is a complex, multistep process. However, it is possible to analyse it in a large programme of trainees in the setting of the modern, busy NHS.