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: 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: 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 [...]

Background: The Charlson comorbidity index (CCI) has been one of the most commonly used and validated prognostication tools. In addition to being a valuable resource for health services researchers, the CCI is being used in clinical practice by hospitals to identify patients at risk for poor outcomes. The use of the CCI in older adults [...]

Background: Delirium is an acute state of brain failure marked by sudden onset of confusion, a fluctuating course, inattention, and often an abnormal level of consciousness. Delirium affects about 11-40% of the hospitalized patient population. In hospital delirium has been associated with 10-fold increased risk for death and a 3-to-5 fold increased risk for nosocomial [...]

Background: Delirium is a common and costly occurrence in hospitalized patients, particularly elderly patients. Diagnosing delirium can be challenging, particularly given the fluctuating nature of presentation and subtle hypoactive motor subtypes. The Brief Confusion Assessment Method (bCAM) is a delirium screening tool that has been validated for use in the med-surg clinical area. As part [...]

Background: Although many older adults will be hospitalized in their lifetime, most do not consider or plan ahead for their post-hospitalization support needs. When older adults experience a hospitalization, families often must react to the crisis leaving the older adult out of the decision process (e.g. choosing a skilled nursing facility, caregivers). With PCORI funding, [...]