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Delta Alert

Expanding Gerotrauma Criteria to Improve Patient Outcomes

A 2-Year Study

Wiles, Lynn L. PhD, RN, MSN, CEN; Day, Mark D. BSN, RN, CEN, TCRN

doi: 10.1097/JTN.0000000000000371

Background/Significance: Because of their decreased physical reserve and increased risk of complications, the geriatric trauma patient (GTP) population warrants heightened awareness by clinical staff.

Purpose: The purpose of this study is to determine whether the institution of a third-tier trauma protocol results in a change in GTP outcomes, complications, and mortality rates.

Methods: Researchers conducted a retrospective review of 2 years of data from the trauma registry, hospital quality improvement audits, and patient charts to examine what, if any, patient outcomes were impacted by the institution of the expanded GTP protocol.

Results: Sample homogeneity was determined. Emergency department (ED) length of stay and time to the operating room decreased in the protocol cohort. The rate of complications decreased from 16.4% preprotocol to 1.6% postprotocol. Discharge to home rates in the GTP population improved from 31% preprotocol to nearly 77% postimplementation of the protocol.

Discussion: The expanded GTP protocol front loads evaluation and resuscitation to be consistent with ED trauma protocols already in place. By fast-tracking radiology and laboratory testing, patients injuries are identified and the appropriate consultations are initiated. Appropriate inpatient nursing unit placement is identified or treatment and discharge from the ED are expedited.

Conclusion: The expanded GTP protocol provided early and comprehensive evaluation and interventions for GTPs who fall outside of traditional trauma alert criteria. Patients spend less time in the ED and the hospital. Patients had decreased length of stay in the ED, less complications, and return to home rates showed significant improvement after the protocol was implemented.

School of Nursing Old Dominion University, Per-diem Emergency Department Staff Nurse, Sentara Virginia Beach General Hospital, Virginia Beach (Dr Wiles); and Trauma Services Department, Sentara Virginia Beach General Hospital, Virginia Beach (Mr Day).

Correspondence: Lynn L. Wiles, PhD, RN, MSN, CEN, ODU School of Nursing, 4608 Hampton Blvd, Norfolk, VA 23529 (

The authors declare no conflicts of interest.

Copyright © 2018 by the Society of Trauma Nurses.