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. 2019 Jun 21:5:2333721419858735.
doi: 10.1177/2333721419858735. eCollection 2019 Jan-Dec.

Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes

Sumit Saha  1 , Stephen M DiRusso  1   2 , Scott Welle  2 , Benjamin Lieberman  3 , Joel Sender  1   2 , Ridwan Shabsigh  1   2   4 , Gerard A Baltazar  1   2   3   5
Affiliations

Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes

Sumit Saha et al. Gerontol Geriatr Med. .

Abstract

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (-67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Keywords: clinical geriatrics; falls; institutionalization; rehabilitation.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Schematic of integration of geriatrician consultation for trauma service patients. Note. During the grant period, all ED geriatric patients had access to a daytime GNP stationed in the ED (red arrow). All geriatric trauma service patients began receiving daytime contact with the GNP (yellow arrow). Concurrently and through the present, all geriatric trauma service patients admitted to the hospital receive early consultation with a GNP or geriatric physician (green arrow). ED = emergency department; GNP = geriatric nurse practitioner.
Figure 2.
Figure 2.
Statistically significant increases in total geriatric trauma admissions (diamonds, p < .001), trauma admissions for falls (squares, p < .001), and percentage of geriatric falls (triangles, p = .017).
Figure 3.
Figure 3.
Total number of geriatric fall admissions (diamonds) and percentage of discharge dispositions from 2006 to 2017 for skilled nursing facility (squares) and home (triangles). Note. Changes in discharge disposition after integration of geriatrician consultation in 2013 are statistically significant (p < .001).
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