An Evaluation of a Proactive Geriatric Trauma Consultation Service

作者：Lenartowicz Magda; Parkovnick Meredith; McFarlan Amanda; Haas Barbara; Straus Sharon E; Nathens Avery B; Wong Camilla L^*

来源：Annals of Surgery, 2012, 256(6): 1098-1101.

DOI：10.1097/SLA.0b013e318270f27a

• geriatrics
• models of care
• trauma

Objective: To describe and evaluate an inpatient geriatric trauma consultation service (GTCS). %26lt;br%26gt;Background: Delays in recognizing the special needs of older trauma patients may result in suboptimal care. The GTCS is a proactive geriatric consultation model aimed at preventing and managing age-specific complications and discharge planning for all patients 60 years or older admitted to the St Michael%26apos;s Hospital Trauma Service. %26lt;br%26gt;Methods: This was a before and after case series of patients admitted pre-GTCS (March 2005-August 2007) and post-GTCS (September 2007-March 2010). Study data were derived from a review of the medical records and from the St Michael%26apos;s Hospital trauma registry. Abstracted data included demographics, type of geriatric issues addressed, rate of adherence to recommendations made by the GTCS, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests, and discharge destinations. %26lt;br%26gt;Results: A total of 238 pre-GTCS patients and 248 post-GTCS patients were identified. The rate of adherence to recommendations made by the GTCS team was 93.2%. There were fewer consultation requests made to Internal Medicine and Psychiatry in the post-GTCS group (N = 31 vs N = 18, P = 0.04; and N = 33 vs N = 18, P = 0.02; respectively). There were no differences in any of the prespecified complications except delirium (50.5% pre-GTCS vs 40.9% post-GTCS, P = 0.05). Among patients admitted from home, fewer were discharged to long-term care facilities among the post-GTCS group (6.5% pre-GTCS vs 1.7% post-GTCS, P = 0.03). %26lt;br%26gt;Conclusions: A proactive geriatric consultation model for elderly trauma patients may decrease delirium and discharges to long-term care facilities. Future studies should include a multicenter randomized trial of this model of care.

• 出版日期2012-12