Association of Geriatric Consult Services With Geriatric Processes of Care and Clinical Outcomes in US Trauma Centers.

BACKGROUND

Trauma centers are implementing geriatric-focused processes of care, including geriatric consult services, to improve outcomes for injured older adults. We hypothesized that trauma centers with a geriatric consult service would have more geriatric-focused processes of care and improved hospital-level mortality for injured older adults.

METHODS

We surveyed US trauma centers regarding compliance with geriatric-focused processes of care, including presence of geriatric consult service, palliative care consult service, geriatric pharmacists, screening for frailty, screening for potentially inappropriate home medications, and anticoagulation reversal protocols. Using Trauma Quality Improvement Program data, we calculated hospital-level observed-to-expected (O:E) mortality for patients aged ≥ 65 years treated at surveyed trauma centers, controlling for patient demographics, comorbidities, and injury severity. High-mortality hospitals were defined as those in the highest quartile of O:E ratio for mortality. Multivariable logistic regression was performed to assess the association of geriatric consult service availability with high-mortality hospitals while controlling for other hospital-level characteristics, including trauma verification level, number of beds, geriatric trauma volume, teaching status, and compliance with other geriatric-focused processes of care.

RESULTS

Geriatric consult services were available at 49 of the 145 included trauma centers (34%). Hospitals with geriatric consult services were more likely to have Level I verification (61% vs. 12%, p < 0.001), standardized processes for assessing frailty (43% vs. 15%, p < 0.001), and geriatric pharmacists (55% vs. 33%, p = 0.012). On unadjusted analysis, hospitals with a geriatric consult service were less likely to have higher-than-expected mortality (17% vs. 44%, p = 0.009). On multivariable logistic regression, the presence of a geriatric consult service was associated with decreased odds of higher-than-expected mortality (OR 0.20, 95% CI 0.05-0.73, p = 0.015).

CONCLUSIONS

Trauma centers with geriatric consult services have improved hospital-level mortality for injured older adults and have more processes in place to manage these patients. Additional trauma centers should consider implementing a geriatric consult service.