Department of Research, Sponsored Programs, and Innovation (Dr Moran) and Division of Palliative Care, Department of Internal Medicine (Drs Soltis and Politis), Summa Health, Akron, Ohio; Division of Trauma, Department of Surgery, Summa Health System-Akron Campus, Akron, Ohio (Drs Moran and George); BIOSTATS, Data Analysis for Clinical Research Studies, East Canton, Ohio (Mr Gothard); and Northeast Ohio Medical University, Rootstown (Dr George).
J Trauma Nurs. 2021;28(2):119-125. doi: 10.1097/JTN.0000000000000569.
Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients.
In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program.
The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities.
A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (≥85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (≥90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019.
This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.
与美国老年人口的显著增长类似，创伤中心也看到了老年创伤患者的增加。这些患者带来了更多的挑战，例如更有可能分诊不足、死亡率和脆弱性增加。此外，高级指令文件的不同存在增加了老年创伤患者早期姑息治疗咨询的重要性。
2018 年，中西部的一家一级创伤中心审查了美国外科医师学院创伤质量改进计划的姑息治疗最佳实践指南，以确定改进的机会，加强姑息治疗咨询服务和创伤计划之间的合作。
该指南推动了改进，包括文件更改（即扩大姑息治疗咨询触发因素、脆弱性评估、高级指令问题、抑郁筛查以及在绩效改进计划表格上添加姑息治疗咨询部分）和培训（1 小时姑息治疗讲座和 5 小时姑息治疗模拟培训）机会。
3 个月的手动图表审查（2019 年 3 月至 2019 年 5 月）显示，到 2019 年 5 月，87.2%的入院老年创伤患者接受了脆弱性评估，超过了基准（≥85%）。此外，高级护理计划问题（即医疗保健授权书、不复苏命令或生前遗嘱）超过了指南规定的基准（≥90%），到 2019 年 5 月，所有问题都在 95.7%的相同患者图表中被问到并记录下来。
该质量改进项目适用于治疗老年创伤患者的创伤中心；使用指南可以推动变革，以满足各机构的需求。
