Care of the Elderly and Stroke Department
Welcome to the department for Care of the Elderly, we hope that you have an enjoyable and educational experience whilst working with us.
This booklet has been written for medical students and junior doctors and is intended to orientate you to your role, the team and educational opportunities available to you whilst you are with us. If you have any questions, please ask a member of the team.
Care of the Elderly Medical Personnel
Consultants and Specialists
- Dr Nicola Connelly – Consultant Community Geriatrician
- Dr Josh Deb-Barman – Specialist in Stroke & Elderly Medicine (and Orthogeriatrician), Resident Doctor Rota Lead
- Dr Sally Graham – Consultant in Elderly Medicine (with special interests in Acute Frailty and Clinical Lead for Orthogeriatrics)
- Dr Syed Haider - Consultant Stroke & Elderly Medicine) and Clinical Lead for Stroke Medicine
- Dr Lisa Hill - Consultant Community Geriatrician and Clinical Lead for Community Geriatrics
- Dr Michelle McCarthy – Consultant Community Geriatrician and COTE Department Educational Lead
- Dr Dylan Phillips - Consultant in Care of the Elderly Medicine (with special Interest in Surgical Liaison Geriatrics) and Audit Lead
- Dr Saurabh Shandilya - Consultant in Elderly Medicine (with special interest in Orthogeriatrics & Falls) - also Joint Associate Medical Director for Urgent Care)
- Dr Sam Sheppard – Consultant Stroke & Elderly Medicine (and Orthogeriatrician)
- Dr Caroline Veitch – Consultant Geriatrician (with special interest in Surgical Liaison Geriatrics and Acute Frailty) and Mortality & Morbidity Lead
- Dr William Wareing - Consultant in Elderly Medicine (with special interests in Acute Frailty and Movement Disorders) – also Clinical Director for Care of the Elderly Department
- Dr Tim Webster - Consultant Stroke & Elderly (with special interest in Movement Disorders) - also Joint Associate Medical Director for Urgent Care)
- Dr Ei Thant Zin - Consultant in Elderly Medicine (with special interest in Falls and Orthogeriatrics)
Specialty Doctors (Middle Grades)
Dr Pramodh Hettiarachchi (Stroke/COTE)
Dr Loredana Mihalca-Mason (COTE)
Dr Hussam Shabbir (Stroke/COTE)
Dr Yumiko Doi (COTE)
Dr Usman Hassan (Stroke/COTE)
Dr Terence Liang (Stroke/COTE)
COTE and Stroke Secretaries
Amanda Johnston, Karen McCarthy, Hilary Camy
Extensions: -
- 2168
- 6294
- 4527
- 2155
Stroke Coordinators (VOIP 2358, bleep 2348, ext. 5509)
Tom Taylor (Team Leader and Advanced Specialist Nurse Practitioner)
Sue Cotgreave
Charlotte Moffatt
Nicola Derbyshire
Jo Elloy
Hannah Trueman
Care of the Elderly Wards and areas
We currently have four wards on the COCH site and links to the Stroke Rehabilitation Unit and Bluebell Unit (rehabilitation wards at Ellesmere Port Hospital) - although their teams are somewhat separate.
Acute Stroke Unit (ASU) – location “G10”
Doctors: -
- One Consultant Stroke Physician of the Week (SPOW) – usually in 2-week rotations
- Three Middle Grades (SpR / Specialty Doctors) covering the ward and acute stroke thrombolysis
- Five SHOs (GPSTs / IMTs / Trust SHOs)
- One F1
Other Key Staff: -
- Ward Manager: Sister Stephanie Williams
Notes for Stroke Unit: -
The Stroke Physician of the Week (SPOW) role rotates in 2-week blocks. The SPOW conducts a daily morning ward round on ASU as well as providing Stroke Thrombolysis cover and senior cover for the High-Risk TIA Clinic if the daily non-SPOW Stroke clinic Consultant in clinic is away.
The Acute Stroke Unit (ASU) is a purpose-built 24 bedded area. It can be found on the Countess of Chester Hospital NHS Foundation Trust main site within the Main Building (Ground Floor) next to Pharmacy at “G10” and it should be considered a Level 2 area like CCU / RSU / HDU.
It is a true multidisciplinary unit with its own team of highly skilled Neuro-Physiotherapists and Neuro-Occupational therapists and links to Speech & Language, Dieticians, Nutrition specialists and the Stroke Association. There is a dedicated team of Stroke Coordinators led by Tom Taylor (who is also a trained ANP and the designated Stroke Champion).
ASU has cardiac telemetry facilities and four bedded bays, and two side rooms dedicated to acute stroke patients. The four bays are mostly single gender, but there may need to be temporary breaches of this due to imbalance in the number of male/female stroke patients. Each patient (including any non-stroke medical patients) will be reviewed on a daily basis, and once they are identified as being medically optimised, they will either be discharged or if further rehabilitation is needed, they will be transferred to the Stroke Rehabilitation Unit at Ellesmere Port Hospital. There is a general target of 2 discharges/transfers per day in order to maintain adequate flow on the Unit and to create beds for new stroke admissions.
During the working day, there can be direct admissions to the Acute Stroke Unit (including of thrombolysis patients) – these may be clerked in by the ward team (if there is enough staffing) but may already have briefly been seen in the ED by the SPOW or a Middle Grade for a focused Hyperacute Stroke review. After 5pm, it is the on-call medical team who do this as usual or if there is not enough ward staffing, the on-call team may have to come up to clerk them.
Note: New stroke patients are not initially put on prophylactic low molecular weight heparin (LMWH), due to the risk of haemorrhagic transformation. Instead, they get prescribed on EPR+ “Intermittent Pneumatic Compression Sleeves” (IPCs) for one month, after which LMWH can be used as usual. If IPCs are not possible to use (e.g. in peripheral vascular disease, if the patient is a falls risk, bruising or skin breaks, or if they cannot tolerate them), prophylactic LMWH can be given for ischaemic stroke patients (not haemorrhagic stroke patients) two weeks after the stroke.
General COTE wards
Two COTE Consultants are based on the General Care of the Elderly Wards (Modular Ward, 50 and 51). On two days of the week, there is a Consultant-led comprehensive ward round in which every patient on the ward is seen; this is a great opportunity for teaching.
On other days, the Consultants will visit the ward for a business round of any new patients or anyone unwell/potential discharges.
MDT occurs three times a week following ward round.
Modular Ward – Short Stay and General COTE ward (mixed gender patients) – location “G21”
Doctors: -
- Two Consultant COTE Consultants cover at a time
- One Specialty Doctor/SpR
- Two SHOs (GPSTs / IMTs / Trust SHOs)
- One F1
Other Key Staff: -
- Ward Manager: Jocelyn Miles
Ward 50 - General COTE ward (mostly female patients) – location “G18”
Doctors: -
- Two Consultant COTE Consultants cover at a time
- Two-three Specialty Doctors/SpRs
- Four SHOs (GPSTs / IMTs / Trust SHOs)
- One F1
Other Key Staff: -
- Ward Manager: Beverley Roberts
Ward 51 - General COTE ward (mostly male patients) – location “G18”
Doctors: -
- Two Consultant COTE Consultants cover at a time
- Two Specialty Doctors/SpRs
- Five SHOs (GPSTs / IMTs / Trust SHOs)
- One F1
Other Key Staff: -
- Ward Manager: Joanne Parry
Stroke Unit and Bluebell Unit, Ellesmere Port Hospital - around 40 medical/stroke rehabilitation and patients.
- A Stroke Consultant and Hospital at Home GPs provide Consultant cover and visits once weekly
- Two Advanced Nurse Practitioners (ANPs) – Jan Powell (medical) and Nealey Moran (stroke)
SDEC Acute Frailty Unit (AFU)
The AFU operates within the Trust’s SDEC building. It is staffed Monday-Friday by a Geriatrics Consultant, trainee, ACP, Pharmacist and a therapies team.
The AFU team reviews older people presenting to ED with frailty syndromes between 9-5pm. COTE trainees will have timetabled days on AFU during their COTE rotation to provide experience of front door/acute geriatrics and management of frailty syndromes. It is a good opportunity for eportfolio assessments to be completed and can be counted as clinic time for IMT trainees.
Consultant Timetables
All of the consultants rotate through various wards; there is consultant presence (either a full ward round or a short business round of selected patients) every morning on each of the four wards. All clinics are held in the afternoons.
Outpatient Clinics
There is opportunity to gain outpatient clinic experience (all clinics start at 2pm), which all SpRs and SHOs will be timetabled into (the Stroke Registrars also run a TIA clinic).
There is a High-Risk TIA clinic (every afternoon, various locations) and COTE clinics, e.g. Falls Clinic (Tuesdays and Thursdays, Ellesmere Port Hospital), Movement Disorders (Mondays, OPD 4) and General COTE (Tuesdays and Thursdays, OPD 1) clinics; discuss with the Resident Doctors' Rota Coordinator and the Consultant concerned, if you wish to attend these.
Community Facing Experience
The Community Healthy Ageing Team (CHAT), led by Consultants Dr Hill, Dr McCarthy and Dr Connelly, perform Community Geriatrics outreach to the community. CHAT do a range of domiciliary visits, care home visits and intermediate care reviews for patients with frailty syndromes and at risk of hospital attendance. If you wish to attend some community-facing activities, please discuss with the COTE Resident Doctors’ Rota Coordinator, or one of the Community Geriatrics Consultants.
Education in the Department
Educational Objectives
Please plan your educational objectives around the core geriatric problems listed below. Your Personal Development Plan, Work-Based Assessments, presentations and reflective writings should incorporate these educational objectives.
Presentations
You will be required to do at least one presentation at the weekly teaching session during your time with us; we will email you your topic at the beginning of your rotation with us.
Dr Michelle McCarthy is responsible for coordinating the teaching rota; if you are unable to give your presentation on your allotted day, please swap with a colleague (much as you would with an on-call) and email her (michelle.mccarthy7@nhs.net) to inform them of the swap.
You will need to collect teaching feedback forms and send them to your Clinical Supervisors for formal feedback. Your Clinical Supervisor collects your feedback forms and will provide you with a summary report for your appraisal.
Educational Meetings
Most of our Monday COTE lunch time meetings (Ophthalmology Seminar Room from 1-2pm) and Thursday Radiology MDTs (Radiology Seminar Room from 1-2pm) are Drug Company sponsored, and you will be provided with food, although hybrid online attendance (via MS Teams) is also possible. Food will be available from 12:30 pm for Friday Grand Rounds.
Please make sure you attend these meetings unless you are on-call or on leave.
Clinical Audits
Speak to your clinical supervisors during early part of your attachment, if you intend to do any clinical audits. There may be an opportunity to do some re-audits to complete the loop or if you have new Quality Improvement Projects, please speak to Dr Phillips (Audit Lead) during earlier part of your attachment so that you will have time to complete it. You can also discuss any potential Audits or QIPs with Dr Phillips.
Postgraduate Exams
Please discuss with your Educational Supervisor and plan ahead any private study leave in discussion with the Resident Doctor Rota Coordinator. We have regular MRCP PACES teaching in this hospital.
Educational & Clinical Supervisors
Please feel free to discuss with Dr McCarthy individually or with your Educational Supervisors if you have any personal educational objectives. Please arrange initial meeting with your Clinical Supervisor as soon as possible and complete the forms in e-portfolio.
It is your responsibility to complete Work-Based Assessments and update your e-portfolio. Use WPBAs as a prospective learning tool rather than a retrospective tick box exercise. Please inform the doctor who is going to complete your WPBA before the ward rounds and complete it at the end of ward rounds.
Annual and Study Leave, Swaps, etc
Dr Deb-Barman is the COTE Resident Doctor Rota Coordinator and can be contacted at COCH.coterota@nhs.net for leave/sickness/rota-related issues (please do not use his personal email address for these queries). He signs off the annual leave and swap of on-call forms. He will however only authorise the Rota Coordinator part of study leave requests to confirm that the dates are acceptable. Dr Shandilya or Dr Webster will sign off the Associate Medical Director section.
It's generally possible to get your leave allocation on this block, especially as we are a big department where we cross-cover each other. However, please try to organise your leave relatively early on, as it will progressively become much harder the later you leave it.
Generally speaking, we require eleven resident doctors across the four COCH wards as a minimum each day and this is the rule that will be used to judge whether a request is possible to grant or not. Anything less than ten is potentially not safe for the four COCH wards.
Sickness and absence
In the case of sickness, in the first instance juniors should inform Medical Staffing at COCH.medstaff@nhs.net and the COTE Resident Doctors Rota Coordinator at COCH.coterota@nhs.net ideally by 8am, to inform them you will not be coming in and expected duration of absence. It would also be helpful to inform your ward team.
Please also remember to inform Medical Staffing and the COTE Resident Doctors Rota Coordinator upon your return to work.
For Medical Students
Whilst you are attached to us we would expect that you gain a wide exposure to the many facets of Elderly Medicine. This not only includes the inpatients but the many activities that are delivered in an outpatient setting. Hopefully this booklet will have informed you of who and where you can get further training from.
Educational aims could include the topics listed below: -
- Delirium / Dementia
- Falls / Immobility
- Incontinence
- Syncope / Dizziness
- Frailty
- Polypharmacy / Pharmacokinetics / Drug Interactions
- Subspecialties: Stroke & TIA / Parkinson’s Disease / Orthogeriatrics / Osteoporosis
- Rehabilitation and discharge planning
- Ethical and legal issues – need for artificial feeds, complications and ethical issues
- Acute medical illness in elderly – nonspecific presentations, difficulty in applying guidelines and protocols, comorbidities and difficulty in drug therapy
- Palliative care
Consultants, Middle Grades, Resident Doctors, Therapists and Specialist Nurses are a valuable resource in teaching.
Useful Guidelines
All guidelines for the Countess of Chester can be found on the intranet using the following link: http://doclib.xcoch.nhs.uk/Pages/Specialty.aspx
Note: These will only work on Trust Networked computers
Fragility fractures
http://doclib.xcoch.nhs.uk/Documents/The%20Care%20of%20Patients%20with%20Fragility%20Fractures.pdf
Delirium and the 4AT Mental Score Test
VTE Prophylaxis after Stroke
http://doclib.xcoch.nhs.uk/Documents/Guidance%20for%20VTE%20prophylaxis%20after%20Stroke.docx
Guidelines for the Management of Stroke
https://doclib.xcoch.nhs.uk/Documents/Guidelines%20for%20the%20management%20of%20Stroke.doc