12b czarnecki geriatric trauma - cdn.ymaws.com · geriatric trauma 5/2/2018 4 “resources”...
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Geriatric Trauma 5/2/2018
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Geriatric Trauma
Geriatric Trauma 5/2/2018
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2017 Trauma Statistics
Project “Purpose” According to best practice recommendations the geriatric trauma population requires
specialized age specific criteria and guidelines for management in order to achieve optimal outcomes due to :
Increased morbidity and mortality rates
Decrease in normal physiologic reserve
Presence of various Comorbid diseases
Increased risk of complications – Specifically Delirium
Geriatric Trauma 5/2/2018
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“Data Utilized to Drive Change”TQIP
Fall 2017 TQIP Benchmark Report Risk-Adjusted Mortality by Cohort – Elderly
UPSTATE
Odds ratio fell into the 10th
decile, signifying that our elderly trauma patients are 90% more likely to have negative outcomes then those treated at other TQIP hospitals.
“Data Utilized to Drive Change”UHC/Vizient Yearly Outcome Report
All Adult Trauma Patients
>15
Discharge
Year Cases
Mean
LOS
(Obs)
Mean
LOS
(Exp)
LOS
Index
Mean
ICU
Days
Cases With 1 or
More (Any)
Complications
Deaths
(Obs)
Pct
Deaths
(Obs)
Pct
Deaths
(Exp)
Mortality
Index
Pct
Early
Death
2015 422 7.74 6.28 1.23 6.60 29 47 11.14 9.86 1.13 4.27
2016 492 7.48 6.22 1.20 5.88 26 45 9.15 8.13 1.12 2.44
2017 543 6.55 6.23 1.05 5.37 17 44 8.10 7.43 1.09 3.87
All Adult Trauma Patients
>64
Geriatric Trauma 5/2/2018
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“Resources”
Emergency trauma care management, including age specific trauma activation criteria.
Inpatient trauma care management, including fragility scoring, geriatric consultations, medicine consultations and specific nursing training and care interventions.
Increase registry compliance with advance care directive PTA entry.
Increase registry compliance with withdrawal of care entry.
APP/Attending assistance with complication and comorbidity abstraction per TQIP definitions.
“Process” Specific Geriatric Trauma Activation Criteria
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“Process”Geriatric Trauma Patient Defined
“Process” Fragility Scoring
Acute Care for the Elderly (ACE) Consultation:An ACE consultation should be obtained for all Medically Complex Geriatric Trauma Patients as well as on Geriatric Trauma Patients with a
positive FRAIL score.
Fatigue
Resistance (inability to walk up a flight of steps)
Ambulation (inability to walk length of football field)
Illness (5 or more)
Loss of weight (5% or more body weight)*An answer of YES to any of the above indicates a positive FRAIL score*
. Consult to the Hospitalist will be made on admission for:
Consultation of the complex medical geriatric patient for care of acute or ongoing
medical conditions.
Risk stratification of the complex medical geriatric patients requiring surgical
intervention.
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“Process”Nursing Management
Delirium Prevention and Management Nursing Interventions
Orientation
Mobility/Activity
Nutrition & Hydration
Elimination
Socialization
Documented Every 8 hours
“Process” ICDSC
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“Process”CAM
“Process”ICOUGH
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“Process” Safe Discharge
3. Discharge * Begin planning on admission a. Assessment
Home Environment, social supports and possible need for medical equipment and/or home health services.
Patient/family acceptance/denial of nursing home or skilled nursing facility placement.
Need for physical or occupational therapy
b. Provide
Clear discharge diagnosis with clear discharge summary Medication and clear dosing instructions as well as possible reactions. Documentation of reconciliation between outpatient and inpatient medications. Directions for wound care if applicable Provide prescriptions for any new medications if going home or assisted living
facility Education given caregivers, achieving clear understanding of patients conditions Clear Nutrition plan Establish an appointment(s) Clear documentation of incident findings that require follow-up and pending
tests if applicable.
c. Consultations Consider repeat pharmacology consult Consult/Update/Confirm follow up with PCP
Taken from Guideline
“Data Post Process Change”
Vizient/UHC 2018 (QTR 1) Data - Yearly Outcome Report
Discharge
Quarter Cases
Mean
LOS
(Obs)
Mean
LOS
(Exp)
LOS
Index
Mean
ICU
Days
Cases With 1
or More (Any)
Complications
Deaths
(Obs)
Pct
Deaths
(Obs)
Pct
Deaths
(Exp)
Mortality
Index
Pct Early
Deaths
2018‐1 48 6.65 5.77 1.15 4.39 3 2 4.17 6.94 0.60 2.08
All Adult Trauma Patients
>64
100 Geriatric trauma patients consulted by acute care geriatricians in the first 6 months after initiation 8/1/17- 2/1/18
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“Project Resolution or Next Steps”Nurse Driven Research
Fulmer SPICES: An Overall Assessment Tool for Older Adults
S is for Sleep DisordersP is for Problems with Eating or FeedingI is for IncontinenceC is for ConfusionE is for Evidence of FallsS is for Skin Breakdown
“Lessons Learned”
Collaboration
EPIC Bundles
EPIC Reports
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Thank you !