12b czarnecki geriatric trauma - cdn.ymaws.com · geriatric trauma 5/2/2018 4 “resources”...

Geriatric Trauma 5/2/2018

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Geriatric Trauma


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2017 Trauma Statistics

Project “Purpose” According to best practice recommendations the geriatric trauma population requires

specialized age specific criteria and guidelines for management in order to achieve optimal outcomes due to :

Increased morbidity and mortality rates

Decrease in normal physiologic reserve

Presence of various Comorbid diseases

Increased risk of complications – Specifically Delirium


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“Data Utilized to Drive Change”TQIP

Fall 2017 TQIP Benchmark Report Risk-Adjusted Mortality by Cohort – Elderly

UPSTATE

Odds ratio fell into the 10th

decile, signifying that our elderly trauma patients are 90% more likely to have negative outcomes then those treated at other TQIP hospitals.

“Data Utilized to Drive Change”UHC/Vizient Yearly Outcome Report

All Adult Trauma Patients

>15

Discharge

Year Cases

Mean

LOS

(Obs)

Mean

LOS

(Exp)

LOS

Index

Mean

ICU

Days

Cases With 1 or

More (Any)

Complications

Deaths

(Obs)

Pct

Deaths

(Obs)

Pct

Deaths

(Exp)

Mortality

Index

Pct

Early

Death

2015 422 7.74 6.28 1.23 6.60 29 47 11.14 9.86 1.13 4.27

2016 492 7.48 6.22 1.20 5.88 26 45 9.15 8.13 1.12 2.44

2017 543 6.55 6.23 1.05 5.37 17 44 8.10 7.43 1.09 3.87


>64


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“Resources”

Emergency trauma care management, including age specific trauma activation criteria.

Inpatient trauma care management, including fragility scoring, geriatric consultations, medicine consultations and specific nursing training and care interventions.

Increase registry compliance with advance care directive PTA entry.

Increase registry compliance with withdrawal of care entry.

APP/Attending assistance with complication and comorbidity abstraction per TQIP definitions.

“Process” Specific Geriatric Trauma Activation Criteria


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“Process”Geriatric Trauma Patient Defined

“Process” Fragility Scoring

Acute Care for the Elderly (ACE) Consultation:An ACE consultation should be obtained for all Medically Complex Geriatric Trauma Patients as well as on Geriatric Trauma Patients with a

positive FRAIL score.

Fatigue

Resistance (inability to walk up a flight of steps)

Ambulation (inability to walk length of football field)

Illness (5 or more)

Loss of weight (5% or more body weight)*An answer of YES to any of the above indicates a positive FRAIL score*

. Consult to the Hospitalist will be made on admission for:

Consultation of the complex medical geriatric patient for care of acute or ongoing

medical conditions.

Risk stratification of the complex medical geriatric patients requiring surgical

intervention.


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“Process”Nursing Management

Delirium Prevention and Management Nursing Interventions

Orientation

Mobility/Activity

Nutrition & Hydration

Elimination

Socialization

Documented Every 8 hours

“Process” ICDSC


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“Process”CAM

“Process”ICOUGH


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“Process” Safe Discharge

3. Discharge * Begin planning on admission a. Assessment

Home Environment, social supports and possible need for medical equipment and/or home health services.

Patient/family acceptance/denial of nursing home or skilled nursing facility placement.

Need for physical or occupational therapy

b. Provide

Clear discharge diagnosis with clear discharge summary Medication and clear dosing instructions as well as possible reactions. Documentation of reconciliation between outpatient and inpatient medications. Directions for wound care if applicable Provide prescriptions for any new medications if going home or assisted living

facility Education given caregivers, achieving clear understanding of patients conditions Clear Nutrition plan Establish an appointment(s) Clear documentation of incident findings that require follow-up and pending

tests if applicable.

c. Consultations Consider repeat pharmacology consult Consult/Update/Confirm follow up with PCP

Taken from Guideline

“Data Post Process Change”

Vizient/UHC 2018 (QTR 1) Data - Yearly Outcome Report

Discharge

Quarter Cases

Mean

LOS

(Obs)

Mean

LOS

(Exp)

LOS

Index

Mean

ICU

Days

Cases With 1

or More (Any)

Complications

Deaths

(Obs)

Pct

Deaths

(Obs)

Pct

Deaths

(Exp)

Mortality

Index

Pct Early

Deaths

2018‐1 48 6.65 5.77 1.15 4.39 3 2 4.17 6.94 0.60 2.08


>64

100 Geriatric trauma patients consulted by acute care geriatricians in the first 6 months after initiation 8/1/17- 2/1/18


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“Project Resolution or Next Steps”Nurse Driven Research

Fulmer SPICES: An Overall Assessment Tool for Older Adults

S is for Sleep DisordersP is for Problems with Eating or FeedingI is for IncontinenceC is for ConfusionE is for Evidence of FallsS is for Skin Breakdown

“Lessons Learned”

Collaboration

EPIC Bundles

EPIC Reports


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Thank you !

12b czarnecki geriatric trauma - cdn.ymaws.com · geriatric trauma 5/2/2018 4 “resources”...

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