Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

Ho, Vanessa P.; Adams, Sasha D.; O’Connell, Kathleen; Cocanour, Christine S.; Arbabi, Saman; Powelson, Elisabeth B; Cooper, Zara; Stein, Deborah M.

doi:10.1136/tsaco-2021-000677

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…The TQIP GTP guidelines for optimal care 27 are mindful of inherent health care limitations but encourage additional resources and expertise to address the needs of this population. 28 We showed that the programs offered to geriatric patients do not necessarily need so many subset pathways, which can further contribute to confusion, inefficiency, or cost. A single multidisciplinary team specializing in geriatric care and attuned to geriatric needs can be used effectively for trauma or general geriatric populations.…”

Section: Discussionmentioning

confidence: 88%

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GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Considering resources for comprehensive geriatric care, it would be beneficial for geriatric trauma patients (GTPs) and medical patients to be comanaged in one program focusing on ancillary therapeutics (AT): physical therapy, occupational therapy, speech language pathology, respiratory therapy, and sleep wake hygiene. This pilot study describes outcomes of GTPs in a hospital-wide program focused on geriatric-specific AT. METHODS Geriatric trauma patients and geriatric patients were screened by program coordinator for enrollment at one Level II trauma center from August 2021 to December 2022. Enrolled patients (EPs) were admitted to trauma or medicine floors and received repetitive AT with attention to sleep wake hygiene throughout hospitalization and compared with similar nonenrolled patients (NEPs). Excluded patients had any of the following: indication of geriatric syndrome with a fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) score of 5, no frailty with a FRAIL score of 0, comfort focused plans, or arrived from skilled care. Retrospective chart review of demographics and outcomes was completed for both EPs and NEPs. RESULTS A total of 224 EPs (28 trauma [TR]) were compared with 574 NEPs (148 TR). Enrolled patients showed shorter length of stay (mean, 3.8 vs. 6.1; p = 0.0001), less delirium (3.1% vs. 9.6%, p = 0.00222), less time to ambulation (13 hours vs. 39 hours, p = 0.0005), and higher likelihood to discharge home (56% vs. 27%, p < 0.0001) as compared with NEPs. The median FRAIL score was 3 for both groups. Enrolled medical patients ambulated the soonest at 11 average hours, compared with 23 hours for enrolled trauma patients and 39 hours for NEPs. There were zero delirium events among enrolled trauma patients; 25% was found among nonenrolled trauma patients (p = 0.00288). CONCLUSION Despite a small trauma cohort, results support feasibility to include GTPs in hospital-wide programs with geriatric-specific AT. Mobility and cognitive strategies may improve opportunities to avoid delirium, decrease length of stay, and influence more frequent disposition to home. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

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Section: Discussionmentioning

confidence: 88%

“…These teams can be costly if used only for trauma patients. The TQIP GTP guidelines for optimal care 27 are mindful of inherent health care limitations but encourage additional resources and expertise to address the needs of this population 28 …”

Section: Discussionmentioning

confidence: 99%

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

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“… 39 Ho et al demonstrated that specific initiatives, including targeted education, consultations, and nurse-led frailty screening, improved local metrics and outcomes after institutional gap analyses demonstrated areas for improvement. 40 …”

Section: Balancing Financial and Staff Burdens Of Overtriagementioning

confidence: 99%

Geriatric trauma triage: optimizing systems for older adults—a publication of the American Association for the Surgery of Trauma Geriatric Trauma Committee

Egodage,

Ho,

Bongiovanni

et al. 2024

Trauma Surg Acute Care Open

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BackgroundGeriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation.MethodsWe conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older patient, evaluating existing literature and guidelines. Opportunities for improvement or standardization were identified.ResultsOpportunities for improved geriatric trauma triage exist in the pre-hospital setting, in the trauma bay, and continue after admission. They may include physiologic criteria, biochemical markers, radiologic criteria and even age. Recent Trauma Quality Improvement Program (TQIP) Best Practices Guidelines for Geriatric Trauma Management published in 2024 support these findings.ConclusionTrauma systems must adjust to provide optimal care for older adults. Further investigation is required to provide pertinent guidance.

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“…4 5 Shortly after the ACS-TQIP best practice guideline was released, a number of Level 1 trauma centers began implementing and validating practice management guidelines (PMGs) for the role of palliative care in trauma patients, and quickly found that these guidelines increased patient satisfaction, particularly for the care of geriatric trauma patients. 7…”

Section: Introductionmentioning

confidence: 99%

Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients

Goswami,

Baxter,

Schiltz

et al. 2023

Trauma Surg Acute Care Open

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ObjectivesThe American College of Surgeons Trauma Quality Improvement Program (TQIP) and Committee on Trauma released a best practice guideline for palliative care in trauma patients in 2017. Utilization of pediatric palliative care services for pediatric trauma patients has not been studied. We sought to identify patients who received the consultation and develop criteria for patients who would benefit from these resources at our institution.MethodsThe institutional pediatric trauma registry was queried to identify all admissions age 0–17 years old to the pediatric intensive care unit (PICU) or trauma ICU (TICU) from 2014 to 2021. Demographic and clinical features were obtained from the registry. Electronic medical records were reviewed to identify and review consultations to the ComPASS team. A clinical practice guideline (CPG) for palliative care consultations was developed based on the TQIP guideline and applied retrospectively to patients admitted 2014–2021. The CPG was then prospectively applied to patients admitted from March through November 2022.ResultsA total of 399 patients were admitted to the PICU/TICU. There were 30 (7.5%) deaths, 20 (66.7%) within 24 hours of admission. Palliative care consultations were obtained in 21 (5.3%). Of these, 10 (47.6%) patients were infants/toddlers <age 2 years, all had traumatic brain injury, 3 (14.3%) were for suspected child abuse, and many were for “goals of care” or family meetings. When the CPG was applied retrospectively, 109 (27.3%) patients met criteria for consultation. After 8 months of prospective implementation of this CPG, palliative care consultation was obtained in 25% (7 of 28) of pediatric trauma patients admitted to the ICU.ConclusionOur results demonstrate underused potential of the palliative care team to impact the hospital course of critically ill pediatric trauma patients. Ongoing studies will analyze the utility of CPG implementation for early involvement of palliative services in critically ill pediatric trauma patients.Level of EvidenceLevel III (retrospective cohort)

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Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

Cited by 4 publications

References 13 publications

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Geriatric trauma triage: optimizing systems for older adults—a publication of the American Association for the Surgery of Trauma Geriatric Trauma Committee

Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients

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