Trauma Consults by Geriatricians: Looking Into the Black Box

Area of Science:

• Geriatric Medicine
• Trauma Surgery
• Health Services Research

Background:

• Older adults are a vulnerable population in trauma care.
• Standard trauma care may not adequately address the complex needs of geriatric patients.
• The disablement process following trauma can be particularly detrimental for older individuals.

Purpose of the Study:

• To highlight the framework, targeting, and content of a geriatric trauma consult (GTC) for older adults.
• To assess the impact of GTC on patient care and the disablement process.
• To evaluate the efficiency of GTC by geriatricians compared to other models.

Main Methods:

• A performance improvement study was conducted at a Level 1 trauma center.
• Fellowship-trained and certified geriatricians performed GTCs in 98 patients aged 68-100 years.
• Recommendations were analyzed for common themes and interventions.

Main Results:

• The most frequent recommendations included transitions of care (home health, skilled nursing facility, hospice), medication adjustments (antihypertensives, psychotropics), advanced care planning, and specialist referrals.
• GTCs provided comprehensive assessments tailored to geriatric trauma patients.
• Geriatricians identified key areas for intervention to mitigate post-trauma disablement.

Conclusions:

• Targeted GTC by a geriatrician is an efficient comanagement strategy for complex older trauma patients.
• This model offers advantages over mandated geriatric team consultations.
• GTCs hold potential for reducing patient disability and healthcare expenditures in value-based care settings.