• Mary E Moran, Melissa Soltis, Themos Politis, M David Gothard, and Richard L George.
• 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 Apr 1; 28 (2): 119-125.

BackgroundSimilar 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.ObjectiveIn 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.MethodsThe 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.ResultsA 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.ConclusionThis quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.Copyright © 2021 Society of Trauma Nurses.

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