Sustainability of a proactive geriatric trauma consultation service.
Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS.



We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination.



Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home.



Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Camilla L
CL
Wong
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Raghda
R
Al Atia
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Amanda
A
McFarlan
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Holly Y
HY
Lee
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Christina
C
Valiaveettil
From the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (Wong, Al Atia); the Division of Geriatrics, St. Michael's Hospital, Toronto, Ont. (Wong); the Division of Trauma, St. Michael's Hospital, Toronto, Ont. (McFarlan); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Lee, Valiaveettil); and the Department of Surgery, University of Toronto, Toronto, Ont. (Haas).
Barbara
B
Haas
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D005853:Geriatrics / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D057188:Workflow
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