An Interdisciplinary Care Pathway for Frail Geriatric Trauma Patients
*Elizabeth A. Bryant, *Samir Tulebaev, *Manuel Castillo-Angeles, *Steven S. Senglaub, *Lynne O'Mara, *Meghan McDonald, Ali Salim, *Zara Cooper
Brigham and Women's Hospital, Boston, MA
Objective: Frailty is a well-established measure of poor outcomes in geriatric trauma patients. There is little evidence that frailty interventions improve outcomes in this population. Our goal was to determine if an interdisciplinary care pathway for frail trauma patients reduces complications and 30-day readmission.
Design: Retrospective cohort study.
Setting: Academic, urban level I trauma center.
Patients: Trauma patients ≥65 years who screened positive for frailty and admitted to the trauma service between 2015-2017. Patients transferred to other services or died within the first 24 hours were excluded.
Interventions: An interdisciplinary protocol for frail trauma patients including early ambulation, bowel/pain regimens, non-pharmacological delirium prevention, nutrition/physical therapy consults, and geriatrics assessments was implemented in 2016.
Main Outcome Measures: Delirium, any complication, and 30-day readmission were compared one year before (pre-cohort) and one year after (post-cohort) protocol implementation.
Results: There were 127 and 148 frail patients in the pre- and post-cohorts, respectively. There were no significant demographic differences between the two groups. For the entire cohort, mean age was 83.55 (SD 7.16), 60.50% were female, and median ISS was 10 (IQR 8-14). While there was no significant difference in complications (28.4% vs. 30.4%, p=0.79), there was a trend towards decreasing delirium incidence (21.3% to 13.5%, p=0.08). 30-day readmission significantly decreased 9.5% to 2.7% (p=0.02). After adjusting for patient characteristics, post-cohort patients had lower delirium (Odds Ratio [OR] 0.49, 95% CI 0.25-0.95, p=0.037) and 30-day readmission rates (OR 0.25, 95% CI 0.07-0.83, p=0.025), compared with pre-cohort patients.
Conclusions: An interdisciplinary care protocol for frail geriatric trauma patients significantly decreases their delirium and 30-day readmission risk. Implementing pathways standardizing care for these vulnerable patients could improve their outcomes following trauma.
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