Integrating Geriatric Consults into Routine Care of Older Trauma Patients: One-Year Experience of a Level I Trauma Center
Integrating Geriatric Consults into Routine Care of Older Trauma Patients: One-Year Experience of a Level I Trauma Center
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DOI：
10.1016/j.jamcollsurg.2015.12.058
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发表时间：
2016-06-01
影响因子：
5.2
通讯作者：
Cooper, Zara
中科院分区：
文献类型：
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作者：
Olufajo, Olubode A.;Tulebaev, Samir;Cooper, Zara
背景：虽然老年创伤患者护理中的老年医生参与与护理流程的改变和结果的改善有关，但我们的服务很少订购老年医生会诊。STUDY设计：2013年9月，我们为所有70岁及以上入院的创伤患者启动了强制性的老年会诊。我们前瞻性地收集了2013年10月至2014年9月(干预后)入院患者的数据，并将他们的数据与2011年6月至2012年6月(干预前)入院患者的数据进行了比较。我们收集了护理过程(DNR和不插管状态、精神错乱和转诊以进行认知评估)和患者结果(死亡率、再入院和住院时间)的数据。结果：干预前和干预后队列中分别包括215名和191名患者。老年会诊比例由干预前的3.26%上升到干预后的100%。有DNR且未插管的患者从10.23%增加到38.22%(p<；0.01)。正式认知评估的转介比例从2.33%增加到14.21%(p<；0.01)，精神错乱的转介比例从31.16%增加到38.22%(p=0.14)。干预前后住院病死率和30天病死率分别为9.30%和5.24%(P=0.12)和11.63%和6.81%(P=0.10)。重症监护病房再住院率干预前为8.26%，干预后为1.96%(p=0.06)。在30天的再次住院和住院时间方面没有变化。能量分析表明，需要更多的患者才能显示统计上的显著结果。结论：在我们的创伤服务中开始强制性的老年会诊与改进的提前护理计划和增加的多学科护理有关。确保老年医生的参与可以帮助减少老年创伤患者的不良后果。(C)2016年由美国外科医师学会主办。由Elsevier Inc.出版。保留所有权利。)
BACKGROUND: Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations were ordered on our service.STUDY DESIGN: Mandatory geriatric consults were initiated in September 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from October 2013 through September 2014 (postintervention) and compared their data with those of patients admitted from June 2011 through June 2012 (preintervention). We collected data on processes of care (DNR and do not intubate status, delirium, and referral for cognitive evaluation) and patient outcomes (mortality, readmission, and length of stay). Descriptive statistics and post-hoc power analyses were performed.RESULTS: There were 215 and 191 patients included in the preintervention and postintervention cohorts, respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients with DNR and do not intubate status increased from 10.23% to 38.22% (p < 0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% (p < 0.01) and delirium documentation increased from 31.16% to 38.22% (p = 0.14). In-hospital mortality and 30-day mortality in the pre- and postintervention periods were 9.30% vs 5.24% (p = 0.12) and 11.63% vs 6.81% (p = 0.10), respectively. Intensive care unit readmission rate was 8.26% preintervention and 1.96% postintervention (p = 0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes.CONCLUSIONS: The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians can aid in reducing adverse outcomes among geriatric trauma patients. ((C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)