I previously wrote about the impact of adding a hospitalist to the trauma service to improve care of geriatric trauma patients. Method Dallas Medical Center created a specific geriatric trauma service, which they called the G-60 service, in 2009. They published their data after one year of experience in 2012.
All patients 60 years of age and older with injuries <48 hours old were admitted to a specific hospital unit. All admitted patients were seen immediately by the trauma surgeon and a hospitalist. Other involved services included rehab, palliative care, PT and OT, pharmacy, nutrition, respiratory therapy, and social work, as needed. The hospitalist was also tasked with expedited clearance for surgical procedures.
Time-to-care goals included G-60 service activation and ED evaluation within 30 minutes, admission to the G-60 unit within 4 hours, operative procedures (if needed) within 36 hours, and discharge within 5 days if appropriate. Multidisciplinary rounds with the full complement of personnel were held twice weekly.
A total of 393 patients were admitted to the G-60 service over a period of one year. A control group of 280 patients from the year before implementation were used for comparison.
Here are the factoids:
- Mechanism of injury was blunt 98% of the time, as expected. Most were falls, and the frequency increased from 68% to 75% after implementation of G-60.
- ICU admission rate remained steady at about 20%
- Significant time-to-care decreases were seen in all 4 categories. ED length of stay decreased by 2 hours, and time to OR decreased by more than half a day.
- Hospital length to stay decreased from 7 to 5 days, and ICU LOS decreased from 5 to 3 days. Both were statistically and financially significant.
- There were significant decreases in the incidence of complications, including UTI, renal failure, CHF, ventilator associated pneumonia, and respiratory failure.
- There was no change in DVT or PE rates.
Bottom line: Implementation of a multidisciplinary trauma service that addresses the special problems of injured elderly patients improves outcomes, and would appear to save a lot of money. I have observed a very obvious age shift in the trauma population at my own trauma center, and I know quite a few other trauma medical directors who are seeing the same thing. We are all going to need to develop the equivalent of a G-60 service to improve outcomes and reduce the financial challenges of taking care of these patients. However, using age 60 as the threshold will miss a number of elders who might benefit. Frailty measures and common sense will need to be taken into account to make sure all appropriate patients can benefit from this type of service.
Reference: Geriatric trauma service: A one-year experience. J Trauma 72(1):119-122, 2012.