Geriatric team improves outcomes in elderly emergency department patients

Nov 19 2012

By Sarah Guy, medwireNews Reporter

Collaboration between trauma and geriatric specialists can improve outcomes for elderly patients admitted to the emergency department, indicate Canadian study findings.

The implementation of a geriatric trauma consultation service (GTCS) that reviews patients within 72 hours of admittance reduced the rate of delirium and the number of patients discharged to long-term care facilities, report the researchers.

There was also a trend toward a reduced length of hospital stay among patients treated after the GTCS was introduced.

"Seeing a reduction in the risk of developing delirium for these patients was a very significant finding," commented study author Camilla Wong (University of Toronto, Ontario) in a press release, adding that "developing delirium in hospital has been associated with morbidity, longer length of hospital stay, increased hospital-acquired complications, and permanent cognitive decline, such as developing dementia."

A total of 248 patients aged 60 years and over were treated by the GTCS team at St Michael's Hospital level 1 trauma center in Toronto between September 2007, when the protocol was introduced, and March 2010.

The researchers compared outcomes for these individuals, including in-hospital complications (eg, falls and delirium) and trauma quality indicators (eg, pneumonia and cardiac arrest) with data for 238 same-age patients treated at the center during a pre-GTCS period (March 2005 to August 2007).

Overall, 3.8% of patients received a comprehensive geriatric assessment prior to GTCS implementation, compared with 59.4% afterward, with sensory impairment, pain, and medication reconciliation the most common concerns addressed, note Wong et al in the Annals of Surgery.

The team observed significantly fewer consultation requests to internal medicine and psychiatric departments after implementation of the GTCS, and rates of delirium were significantly lower post- compared with pre-GTCS, at 40.9% versus 50.5%.

Furthermore, significantly fewer post-GTCS patients admitted to the emergency department from home were discharged to a long-term care facility compared with their pre-GTCS counterparts, at 1.7% versus 6.5%, and there was also a moderately significant trend toward decreased length of stay pre- compared with post-GTCS, at 15.4 versus 19.4 days.

"The core feature in these proactive consultation models is early involvement in the prevention and management of geriatric syndromes, function preservation, and discharge planning, rather than the traditional models that rely on a reactive strategy," conclude Wong and team.

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