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An Evaluation of a Proactive Geriatric Trauma Consultation Service

Lenartowicz, Magda MD*; Parkovnick, Meredith MSc; McFarlan, Amanda BA; Haas, Barbara MD; Straus, Sharon E. MD, MSc§; Nathens, Avery B. MD, PhD, MPH; Wong, Camilla L. MD, MHSc§

doi: 10.1097/SLA.0b013e318270f27a
Original Articles

Objective: To describe and evaluate an inpatient geriatric trauma consultation service (GTCS).

Background: Delays in recognizing the special needs of older trauma patients may result in suboptimal care. The GTCS is a proactive geriatric consultation model aimed at preventing and managing age-specific complications and discharge planning for all patients 60 years or older admitted to the St Michael's Hospital Trauma Service.

Methods: This was a before and after case series of patients admitted pre-GTCS (March 2005–August 2007) and post-GTCS (September 2007–March 2010). Study data were derived from a review of the medical records and from the St Michael's Hospital trauma registry. Abstracted data included demographics, type of geriatric issues addressed, rate of adherence to recommendations made by the GTCS, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests, and discharge destinations.

Results: A total of 238 pre-GTCS patients and 248 post-GTCS patients were identified. The rate of adherence to recommendations made by the GTCS team was 93.2%. There were fewer consultation requests made to Internal Medicine and Psychiatry in the post-GTCS group (N = 31 vs N = 18, P = 0.04; and N = 33 vs N = 18, P = 0.02; respectively). There were no differences in any of the prespecified complications except delirium (50.5% pre-GTCS vs 40.9% post- GTCS, P = 0.05). Among patients admitted from home, fewer were discharged to long-term care facilities among the post-GTCS group (6.5% pre-GTCS vs 1.7% post-GTCS, P = 0.03).

Conclusions: A proactive geriatric consultation model for elderly trauma patients may decrease delirium and discharges to long-term care facilities. Future studies should include a multicenter randomized trial of this model of care.

This is a before and after case series evaluation of a novel model of care—an inpatient geriatric trauma consultation service (GTCS). Four hundred eighty-six records of older patients consecutively admitted to the Trauma service were reviewed with a focus on geriatric-specific in-hospital complications, trauma quality indicators, subspecialty consultation requests, and discharge destinations. The GTCS was associated with decreased rates of delirium, consultations to psychiatry and medicine, and discharge to long-term care facilities.

*Department of Medicine, University of Saskatchewan, Saskatchewan, Canada

Division of Trauma, St. Michael's Hospital

Department of Surgery, St. Michael's Hospital

§Division of Geriatric Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital

Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Canada.

Reprints: Camilla L. Wong, MD, MHSc, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. E-mail: camilla.wong@utoronto.ca.

Disclosure: This study was financially supported by the Department of Medicine, Division of Trauma, and Keenan Research Centre, St Michael's Hospital, University of Toronto, Ontario, Canada.

© 2012 Lippincott Williams & Wilkins, Inc.