Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines

J Surg Res. 2017 Aug;216:56-64. doi: 10.1016/j.jss.2017.03.023. Epub 2017 Mar 31.

Abstract

Background: The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures.

Methods: This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma).

Results: The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P < 0.01) and better documentation of initial living situation, code status, and medication list in the GeriTrauma group. Physical therapy was consulted more frequently for GeriTrauma patients (95.7% vs 68.0%, P < 0.01) Documented goals of care discussions were rare and difficult to abstract. A subgroup analysis of only patients with fall-related injuries demonstrated similar outcomes.

Conclusions: Early geriatric consultation increases adherence to TQIP guidelines. Further research into the long term significance and validity of these geriatric trauma quality indicators is needed.

Keywords: Geriatric consultation; Geriatrics; Quality measures; TQIP; Trauma.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Geriatric Assessment / statistics & numerical data*
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Practice Guidelines as Topic
  • Quality Improvement / statistics & numerical data*
  • Quality Indicators, Health Care / statistics & numerical data
  • Retrospective Studies
  • Trauma Centers / standards*
  • Trauma Centers / statistics & numerical data
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / therapy*