Background: At our Level 1 trauma center, geriatric trauma (GT) patients are primarily managed by hospitalists with surgical consultation. This care model offloads the trauma surgical services, improving time to surgery and hospital throughput. As the number of injured GT patients rose, so did the need to address a higher complication risk, longer hospital stays, and post-acute placement. Since 2018, yearly GT-centered educational efforts focused on venous thromboembolism prophylaxis, expedited pre-operative cardiac and pulmonary optimization, post-operative complications and delirium management. Evidence-based bundled order sets for geriatric pain management and delirium prevention were created to diminish variations in care. GT dedicated hospitalists obtained ATLS certification and participated in trauma quality conferences. We hypothesize that this practice model improves efficiency in care delivery and resource utilization over time.
Methods: We performed a retrospective study of trauma patients age ≥65 admitted to our hospital from January 1, 2016, through December 31, 2021. We analyzed yearly changes in length of stay, direct pharmacy, radiology, supplies and laboratory costs, and discharge disposition among all GT patients, and specifically among geriatric patients with the primary admitting diagnosis of femur fracture (ICD10 S72).
Results: Since 2016, 3,300 GT patients were admitted to the hospitalist service. The average age was 81 years old, injury severity score (ISS) was 10, and length of stay (LOS) was 6.5 days. Of these, 984 were admitted with the primary diagnosis of femur fracture. Details of GT patient hospitalizations are depicted in Table 1.Despite a threefold rise in GT admissions over the study period, readmission rates were unchanged. LOS was stable for patients with femur fractures. There was a reduction in the percentage of femur fracture patients who discharged to skilled nursing facility (SNF), which was offset by the rise in discharge to inpatient rehabilitation (IPR). Direct pharmacy costs improved with time for all GT patients, with a trend towards improvement in the femur fracture patients. Among the 9 patients who died while in hospital, the average age was 85, and LOS was 5.7 days. Seven of the 9 patients changed status to “comfort measures only,” before dying.
Conclusions: Focused educational efforts, bundled order sets and a dedicated cohort of physicians participating in this care model allowed an efficient absorption of a threefold rise in geriatric trauma patient admissions without affecting LOS or readmissions. Rate of discharge to SNF or IPR remained between 68-71%, and rate of discharge to home was stable. Reduced pharmacy costs also reflect efficiencies gained with this care model.
