Frailty Interdisciplinary Pathway: Compliance and Sustainability in a Level I Trauma Center

Lynne O Mara, MPAS, PA-C
Department of Surgery
Division of Trauma, Burn and Surgical Critical Care
Poster Overview

Background

Frailty is a state of physical vulnerability that predisposes many older adult trauma patients to poor health outcomes. Specialized care pathways for frail trauma patients have been shown to improve outcomes, but the ability to comply with and sustain these pathways has not been reported.

 

Methods

We measured clinical staff compliance to 19 frailty pathway elements for 279 patients age 65 and older from October 1, 2016 to September 30, 2018 at a Level I trauma center. Benchmark compliance was >75%.

 

Results

The average compliance to all pathway elements was 68.2% and improved from Year 1 (65.0%) to Year 2 (71.4%). Seven elements achieved an average compliance >75% over the two-year period: frailty screening (92.8%), consultation requests for physical therapy (97.9%), geriatrics (96.2%), and nutrition (92.3%), consultant care within 72 hours of admission (78.0%), delirium screening (76.3%), and bowel medication administration (76.0%). Compliance to 10 elements significantly improved from Year 1 to Year 2 and significantly worsened in 2 elements.

 

Conclusion

Many standardized geriatric care processes for frail older adult trauma patients can be successfully integrated into daily clinical practice and sustained over time. More studies are needed to better understand which pathway elements are most effective.

Scientific Abstract

Background

Frailty is a state of physiological vulnerability that predisposes many older adult trauma patients to poor health outcomes. Specialized care pathways for frail trauma patients have been shown to improve outcomes, but the compliance and sustainability of these pathways have not been reported.

 

Methods

We retrospectively measured compliance to 19 pathway elements for 279 patients age 65 and older from October 1, 2016 to September 30, 2018 at a Level I trauma center. Benchmark compliance was >75%.

 

Results

Retrospective two-year mean overall compliance to all pathway elements was 68.2% and improved from Year 1 (65.0%) to Year 2 (71.4%). Seven elements achieved a mean >75% compliance over the two-year period: frailty screening (92.8%), consultation requests for physical therapy (97.9%), geriatrics (96.2%), and nutrition (92.3%), consultant care within 72 hours of admission (78.0%), delirium screening (76.3%), and senna administration (76.0%). Compliance to 10 elements significantly improved from Year 1 to Year 2 and significantly worsened in 2 elements.

 

Conclusion

Many standardized geriatric care processes for frail older adult trauma patients can be successfully integrated into routine daily inpatient practice and sustained over time. More studies are needed to better understand which pathway elements are most effective.

Clinical Implications
Many standardized care processes for frail, older adult trauma patients can be successfully integrated into daily clinical practice, complied with, and sustained over time.
Research Areas
Authors
Lynne O Mara, MPAS, PA-C, Katherine Palm, MSW, Manuel Castillo-Angeles, MD, MPH, Elizabeth Bryant, MPH, Esther Moberg, MPH, Katherine Armstrong, MPH, Nikita Patel, Samir Tulebaev, MD, Meghan McDonald, MSN, RN, Diane Tsitos, MSN, RN, Zara Cooper, MD, MSc
Principal Investigator
Zara Cooper, MD

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