Background: Trauma co-management is a growing field within hospital medicine. While improvements in quality metrics have been documented in other co-management services, the impact of co-management of trauma patients is uncertain. This study aimed to determine whether a hospitalist trauma co-management program improves clinical outcomes. Methods: This was a pre- and post-implementation study comparing trauma [...]

Background: The 2014 ACC/AHA Perioperative Guidelines suggest using the Revised Cardiac Risk Index (RCRI), myocardial infarction or cardiac arrest (MICA), or American College of Surgeons (ACS)-NSQIP calculators for combined patient-surgical risk assessment. Alrezk and colleagues recently published a new geriatric-sensitive cardiac risk index (GS-CRI) to predict MI or cardiac arrest in the geriatric population. We [...]

Background: Geriatric and palliative care patients who have been discharged from hospital and are home-limited face challenges in effectively accessing ongoing healthcare and clinical follow-up after being discharged, leaving them at risk for unnecessary re-hospitalization. Health care video visits present a novel opportunity to expand patient access to clinical care remotely in their home, potentially [...]

Background: Elderly inpatients often require the support of family and informal caregivers at transitions and yet adequacy of communication between hospital physicians and members of the patient’s social support is poorly studied. Methods: Mixed methodology survey of patients, their preferred social support member, and physicians as part of a communication quality improvement initiative on the [...]

Background: Family members often play a significant role in the care of geriatric patients during and after hospitalization. Both patients and families have expectations for communication with the provider team in the acute setting, but navigating the flow of medical information across the family unit is challenging with current care models. Pediatric medicine recognizes that [...]

Background: Hip fractures are one of the most common causes for surgery in the elderly and the burden of care extends beyond the perioperative period as many are discharged to a long-term facility and have significant morbidity and mortality despite advances in perioperative care. To date, trials of interventions and standardized multidisciplinary hip fracture programs [...]

Background: The Palo Alto VA Hospital has an interdisciplinary Clinical Command Center (C3) that includes “Flow” nurse practitioners (NPs) who work closely with case management, social work and primary medical teams to identify and address barriers to care and assist in discharge planning and coordination. We have created a novel collaboration between a C3 Flow [...]

Background: Our institution is a Level 1 regional trauma center with a large inpatient volume. A large percentage of these patients are elderly, with the traumatic events occurring as sequelae of their age, debility or medical complications. Last year, we developed a Trauma/Acute Care Surgery Hospitalist Co-Management program, due to, in large part, the increasing [...]

Background: Today, Medicare patients account for approximately 50% of hospital days. Hospitalists are a key strategy for providing care to hospitalized older adults, however, most of these hospitalists have not received geriatric training. Faculty development is an important component to the success of a hospitalist program. We developed a geriatric-focused lecture series to improve the [...]

Background: Many hospitals do not have the means to supervise daily physical therapy (PT) for elderly inpatients. PT delivered in a group setting has the potential to allow hospitals to consolidate resources and extend PT services to more elderly patients within the hospital. However, little to no efforts have been made in implementing the delivery [...]