Developing a Geriatric Trauma Program

Traumatic injury in the geriatric population is increasing and is associated with higher mortality and morbidity compared to younger patients. Decreased physical reserve, various comorbid diseases, and an increased risk of elderly complications such as delirium has called for the development of geriatric specific care and protocols. The idea to employ better risk assessments, incorporate preventative strategies, improve surveillance and recognition of complications when they occur will reduce mortality and morbidity in the geriatric trauma patient population.

I. Objective: A multidisciplinary approach will be used to improve geriatric trauma patient care and decrease morbidity and mortality.

II. Multidisciplinary Team could consist of:

• Trauma Surgeon (lead)
• Nurse Supervisor
• Geriatrics
• Physical /Occupational Therapists
• Emergency Services
• Respiratory Therapists
• Neurosurgery
• Nutritionists
• Anesthesia
• Palliative Care
• Internal Medicine
• Case Coordinators
• Cardiology Orthopedics
• Registered Nurses Advanced Practice Providers
• Pharmacy
• Speech Therapy
• Hospital administrators
• Trauma Coordinators
• Social Workers
• Injury Prevention Coordinator

III. Geriatric Trauma Program Goals:
A. 30 minutes from emergency department presentation to trauma service evaluation
B. 4 hours from emergency department presentation to inpatient room
C. 36 hours from emergency department presentation to operating room
D. 5 days from emergency department to safe and appropriate discharge/disposition

IV. Criteria:
A. Age 65 years old or greater
B. Traumatic injury requiring hospitalization (primary diagnosis for initial admission must be acute, identifiable injury, which on its own, regardless of age, would require an admission to the hospital for treatment)

V. Discharge Planning
A. Within 24 hours of admission, all must have a pre-planned disposition, agreed upon by the patient, and/or family and the admitting physician

VI. Geriatric Trauma Activation
A. Seen first by an emergency department physician to establish criteria
B. Geriatric team notification
C. Goal of activation to exam of 30 minutes
a. Seen by trauma service initially
D. Appropriate sub-specialists notified
E. Expedited pre-procedure medical clearance
F. Admitted to SICU or geriatric unit (geriatric trauma service)

VII. Multidisciplinary Rounds
A. Team Members could include:

• Trauma Surgeon
• Occupational Therapist
• Nurse Practitioner
• Physical Therapist
• Registered Nurse
• Chaplin
• Respiratory Therapist
• Trauma Clinical Coordinator
• Nurse Manager
• Social Workers

References

1. ACS TQIP Geriatric Trauma Management Guidelines. Available at: https://www.facs.org/~/media/files/quality%20programs/trauma/tqip/geriatric%20guide%20tqip.ashx. Accessed March 8, 2016.

2. An innovative program designed to improve geriatric trauma patient care at Methodist Dallas. Available at: www.methodisthealthsystem.org/blank.cfm?print=yes&iirf_redirect=1&id_3811. Accessed March 4, 2016.

3. Managram, A. J. G60-Geriatric Trauma. Available at: https://intermountainphysician.org/intermountaincme/Documents/02_Sat_Mangram_G60%20Trauma.pdf. Accessed March 8, 2016.

4. Managram, A. J., Shifflette, V. K., Mitchell, C. D., Johnson, V. A., Lorenzo, M., Truitt, M. S.. . Dunn, E. L. (2011). The creation of a geriatric trauma unit "G-60". The American Surgeon, 77(9), 1144.

Resources

ACS TQUIP Geriatric Trauma Management Guidelines
ACS NSQIP Geriatric 2016 Guidelines
Geriatric Trauma Service: A One Year Experience
The Creation of a Geriatric Trauma Unit “G60”