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. 2024 May;50(4):841-849.
doi: 10.1016/j.burns.2024.02.022. Epub 2024 Feb 29.

Implementation of a geriatric care bundle for older adults with acute burns

Julia Oehlers  1 , Carolyn Blayney  2 , Jo Tate  2 , Alexander Cheng  2 , Andrew Tucker  3 , May J Reed  4 , Barclay T Stewart  5 , Saman Arbabi  5 , Kathleen O'Connell  6 , Elisabeth Powelson  7 , Tam N Pham  5
Affiliations

Implementation of a geriatric care bundle for older adults with acute burns

Julia Oehlers et al. Burns. 2024 May.

Abstract

Background: Frailty and comorbidities are important outcome determinants in older patients (age ≥65) with burns. A Geriatric Burn Bundle (Geri-B) was implemented in 2019 at a regional burn center to standardize care for older adults. Components included frailty screening and protocolized geriatric co-management, malnutrition screening with nutritional support, and geriatric-centered pain regimens.

Methods: This study aimed to qualitatively evaluate the implementation of Geri-B using the Proctor Framework. From June-August 2022, older burn-injured patients, burn nurses, and medical staff providers (attending physicians and advanced practice providers) were surveyed and interviewed. Transcribed interviews were coded and thematically analyzed. From May 2022 to August 2023, the number of inpatient visits aged 65 + with a documented frailty screening was monitored.

Results: The study included 23 participants (10 providers, 13 patients). Participants highly rated Geri-B in all implementation domains. Most providers rated geriatric care effectiveness as 'good' or 'excellent' after Geri-B implementation. Providers viewed it as a reminder to tailor geriatric care and a safeguard against substandard geriatric care. Staffing shortages, insufficient protocol training, and learning resources were reported as implementation barriers. Many providers advocated for better bundle integration into the hospital electronic health record (EHR) (e.g., frailty screening tool, automatic admission order sets). Most patients felt comfortable being asked about their functional status with strong patient support for therapy services. The average frailty screening completion rate from May 2022 to August 2023 was 86%.

Conclusions: Geri-B was perceived as valuable for the care of older burn patients and may serve as a framework for other burn centers.

Keywords: Aged; Burns; Implementation.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.
Frailty score screening completion rate among inpatient burn visits aged 65+.
Figure 2.
Figure 2.
Level of support for Geri-B among providers.
Figure 3.
Figure 3.
Provider’s comfort level with using Geri-B.
Figure 4.
Figure 4.
Level of support for Geri-B among patients.
Figure 5A.
Figure 5A.
Infographic poster for providers which explains the Geri-B care pathway with a QR code link to additional reference materials.
Figure 5B.
Figure 5B.
Infographic poster for patients which explains the components of Geri-B with a QR code link to additional reference materials.
See this image and copyright information in PMC

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