Interdisciplinary Care Pathway Helps Manage Frail, Elderly Trauma Patients
Significant decreases seen in delirium, 30-day readmission, but not complications
THURSDAY, April 25, 2019 (Pharmacist's Briefing) -- An interdisciplinary care protocol for frail geriatric trauma patients significantly reduces the risk for delirium and 30-day readmission, according to a study published online April 5 in the Journal of the American College of Surgeons.
Elizabeth A. Bryant, M.P.H., from Brigham and Women's Hospital in Boston, and colleagues evaluated whether an interdisciplinary care pathway for frail trauma patients (≥65 years) improved in-hospital mortality, complications, and 30-day readmissions. The interdisciplinary protocol included early ambulation, bowel/pain regimens, nonpharmacological delirium prevention, nutrition/physical therapy consults, and geriatrics assessments.
Based on the 125 and 144 frail patients in the preintervention and postintervention cohorts, the researchers observed no significant demographic differences in complications (P = 0.93). However, following the intervention, there was a significant decrease in delirium (21.6 to 12.5 percent; P = 0.04) and 30-day readmission (9.6 to 2.7 percent; P = 0.01). Lower delirium (odds ratio, 0.44; P = 0.02) and 30-day readmission rates (odds ratio, 0.25; P = 0.02) were seen postintervention compared with prepathway patients, even after adjusting for patient characteristics.
"Implementing pathways standardizing care for these vulnerable patients could improve their outcomes following trauma," the authors write.