title: An evaluation of a proactive geriatric trauma consultation service.
abstract: OBJECTIVE
  To describe and evaluate an inpatient geriatric trauma consultation service (GTCS).
  
  
  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's Hospital Trauma Service.
  
  
  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'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.
  
  
  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).
  
  
  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.
authors.affiliation: Department of Medicine, University of Saskatchewan, Saskatchewan, Canada.
authors.forename: Magda
authors.initials: M
authors.lastname: Lenartowicz
authors.forename: Meredith
authors.initials: M
authors.lastname: Parkovnick
authors.forename: Amanda
authors.initials: A
authors.lastname: McFarlan
authors.forename: Barbara
authors.initials: B
authors.lastname: Haas
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Camilla L
authors.initials: CL
authors.lastname: Wong
mesh_terms: D000368:Aged; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy