Integrating Geriatric Consults into Routine Care of Older Trauma Patients: One-Year Experience of a Level I Trauma Center

Olubode A Olufajo; Samir Tulebaev; Houman Javedan; Jonathan Gates; Justin Wang; Maria Duarte; Edward Kelly; Elizabeth Lilley; Ali Salim; Zara Cooper

doi:10.1016/j.jamcollsurg.2015.12.058

Integrating Geriatric Consults into Routine Care of Older Trauma Patients: One-Year Experience of a Level I Trauma Center

J Am Coll Surg. 2016 Jun;222(6):1029-35. doi: 10.1016/j.jamcollsurg.2015.12.058. Epub 2016 Mar 3.

Authors

Affiliations

¹ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA. Electronic address: oao777@mail.harvard.edu.
² Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
³ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
⁴ Surgical ICU Translational Research Center, Brigham and Women's Hospital, Boston, MA.
⁵ Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
⁶ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.

PMID: 26968324
DOI: 10.1016/j.jamcollsurg.2015.12.058

Abstract

Background: Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations were ordered on our service.

Study design: Mandatory geriatric consults were initiated in September 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from October 2013 through September 2014 (postintervention) and compared their data with those of patients admitted from June 2011 through June 2012 (preintervention). We collected data on processes of care (DNR and do not intubate status, delirium, and referral for cognitive evaluation) and patient outcomes (mortality, readmission, and length of stay). Descriptive statistics and post-hoc power analyses were performed.

Results: There were 215 and 191 patients included in the preintervention and postintervention cohorts, respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients with DNR and do not intubate status increased from 10.23% to 38.22% (p < 0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% (p < 0.01) and delirium documentation increased from 31.16% to 38.22% (p = 0.14). In-hospital mortality and 30-day mortality in the pre- and postintervention periods were 9.30% vs 5.24% (p = 0.12) and 11.63% vs 6.81% (p = 0.10), respectively. Intensive care unit readmission rate was 8.26% preintervention and 1.96% postintervention (p = 0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes.

Conclusions: The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians can aid in reducing adverse outcomes among geriatric trauma patients.

Publication types

Clinical Trial

MeSH terms

Aged
Aged, 80 and over
Female
Geriatric Assessment* / methods
Geriatric Assessment* / statistics & numerical data
Geriatrics
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data
Interdisciplinary Communication
Length of Stay / statistics & numerical data
Male
Outcome and Process Assessment, Health Care
Patient Admission / statistics & numerical data
Patient Care Planning* / organization & administration
Patient Care Planning* / statistics & numerical data
Patient Readmission / statistics & numerical data
Prospective Studies
Referral and Consultation* / organization & administration
Referral and Consultation* / statistics & numerical data
Trauma Centers / organization & administration*
Trauma Centers / statistics & numerical data
Traumatology
Wounds and Injuries / mortality
Wounds and Injuries / therapy*