title: Integrating Geriatric Consults into Routine Care of Older Trauma Patients: One-Year Experience of a Level I Trauma Center.
abstract: Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations were ordered on our service.
  
  
  
  Mandatory geriatric consults were initiated in September 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from October 2013 through September 2014 (postintervention) and compared their data with those of patients admitted from June 2011 through June 2012 (preintervention). We collected data on processes of care (DNR and do not intubate status, delirium, and referral for cognitive evaluation) and patient outcomes (mortality, readmission, and length of stay). Descriptive statistics and post-hoc power analyses were performed.
  
  
  
  There were 215 and 191 patients included in the preintervention and postintervention cohorts, respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients with DNR and do not intubate status increased from 10.23% to 38.22% (p < 0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% (p < 0.01) and delirium documentation increased from 31.16% to 38.22% (p = 0.14). In-hospital mortality and 30-day mortality in the pre- and postintervention periods were 9.30% vs 5.24% (p = 0.12) and 11.63% vs 6.81% (p = 0.10), respectively. Intensive care unit readmission rate was 8.26% preintervention and 1.96% postintervention (p = 0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes.
  
  
  
  The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians can aid in reducing adverse outcomes among geriatric trauma patients.
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA. Electronic address: oao777@mail.harvard.edu.
authors.forename: Olubode A
authors.initials: OA
authors.lastname: Olufajo
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Samir
authors.initials: S
authors.lastname: Tulebaev
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Houman
authors.initials: H
authors.lastname: Javedan
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gates
authors.affiliation: Surgical ICU Translational Research Center, Brigham and Women's Hospital, Boston, MA.
authors.forename: Justin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Maria
authors.initials: M
authors.lastname: Duarte
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kelly
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lilley
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D005853:Geriatrics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010347:Patient Care Planning / Q000458:organization & administration / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014194:Traumatology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*