Improving a Mature Palliative Care Program at a Level I Trauma Center.

Area of Science:

• Trauma Surgery
• Geriatric Medicine
• Palliative Care

Background:

• Geriatric trauma patients are a growing demographic in trauma centers.
• These patients face higher risks of mortality, undertriage, and frailty.
• Early palliative care is crucial due to complex needs and variable advanced directive documentation.

Purpose of the Study:

• To enhance collaboration between palliative care and trauma services.
• To implement the American College of Surgeons Palliative Care Best Practice Guideline.
• To identify opportunities for improving geriatric trauma patient care.

Main Methods:

• Revised documentation protocols, including palliative care triggers, frailty assessments, and advanced directive inquiries.
• Provided targeted training: a 1-hour lecture and 5-hour simulation.
• Utilized the American College of Surgeons Trauma Quality Improvement Program guideline.

Main Results:

• Frailty assessments reached 87.2% for geriatric trauma patients, exceeding the 85% benchmark.
• Advanced care planning questions were documented in 95.7% of charts, surpassing the 90% benchmark.
• Improvements were observed within 3 months of implementation.

Conclusions:

• This quality improvement initiative demonstrates successful guideline implementation.
• The project offers a scalable model for trauma centers treating geriatric patients.
• Adapting guidelines can meet specific institutional needs for enhanced geriatric trauma care.