Implementing a Trauma Consult Protocol for Geriatric Trauma Patients

Abstract

Geriatric patients are at increased risk for death due to undertriage after a trauma. The purpose of the quality improvement project was to implement a geriatric trauma consult protocol on the elderly population aged 70 and over to identify occult injuries and decrease complications. At the project site, the majority of geriatric trauma patients with a single site injury such as a hip fracture are classified as a level IV trauma. Level IV trauma patients are rarely seen by a member of the trauma team. The inclusion criteria for the project were level IV trauma patients aged 70 years and older with a single site injury admitted under inpatient status by the designated hospitalist group. The hospitalist physician initiated the trauma consult. The project was guided by the Institute of Health Model for Improvement framework and the American College of Surgeons Committee on Trauma recommendations. The protocol was implemented over 14-weeks with biweekly PDSA cycle review and protocol updates. The findings show that 32% of the eligible patients received a trauma consult with zero occult injuries identified. There were no complications in the patients that received a trauma consult. One unplanned ICU admission and four urinary tract infections were recorded in the patients with no trauma consult. The project aligns with the Triple Aim and Healthy People 2030 by providing increased access to care which improves patient experience, improves the health of the aging population, and decreases costs by identifying injuries or illness prior to costly complications.