Change Narrative Abstract - Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Background: As the population ages, older adults are increasingly being admitted to hospital with trauma, with the most common mechanism being low falls. While the orthogeriatric model of care is well-established, there is growing evidence that a shared care model between trauma and geriatrics also improves outcomes. The aim of this improvement project was to improve length of stay (LOS) by decreasing variations in care for frail older adults admitted with trauma.

Change: The frailty bundle project was lead by a geriatrician and developed in conjunction with the trauma surgeons, specialist trauma nurse, allied health and a consumer. Eligible patients were aged 65 and older and admitted to the trauma unit with a clinical frailty score of 4 or above. Baseline data was collected for six months, then intervention data was collected for the following six months. Comparison groups were people admitted to trauma who were not frail and people admitted with trauma to general medicine. The variables measured were: review by geriatrician within 24 hours, documentation of discharge planning within 24 hours, documentation of need for allied health within 24 hours, identification of functional goals for discharge, medication review, number of physiotherapy sessions and discussion at a multidisciplinary meeting (MDT).

After consultation, the improvement focused on communication. The strategies implemented were:

1. Geriatrics team to document likely discharge destination, potential barriers and when medically ready for discharge at first review
2. Twice weekly 30-minute discharge huddles with a geriatrics advanced trainee, trauma clinical nurse specialist and an allied-health representative held on Monday and Friday afternoons to discuss new patients and any important updates, in addition to pre-existing multidisciplinary team meeting
3. Physiotherapy and occupational therapy were encouraged to specify in their documentation what a person needed to achieve functionally to return home and what their current functional status was.

Learnings: The median LOS for patients eligible for the target group before and after the implementation remained the same at 7, over the same time period, median LOS for non-frail patients admitted to trauma went from 6 to 7 (p=0.11) and for general medicine it went from 6 to 8 (p=0.06).

This relative improvement in length of stay, at a time when it was worsening for other patients, demonstrates that an intervention using existing resources, with a focus on improving interdisciplinary communication, is a valid strategy to improve care and patient flow for older adults.