Creating New Opportunities to Educate Families on the Impact of Frailty and Cognitive Impairment in a Trauma Intensive Care Unit: Results of a Quality Improvement Project.

BACKGROUND: Older adults comprise a rapidly growing proportion of admissions to acute care hospitals and trauma centers. Older adults admitted to a trauma intensive care unit (TICU) often have a more complicated inpatient and posthospital course. This is the most pronounced in frail elders with cognitive dysfunction. We aimed at integrating validated screening instruments for physical frailty and cognitive impairment into the standard nursing assessment of all older trauma patients admitted to our TICU and stepdown unit.

OBJECTIVES: Our goal, for positive screens, was to trigger earlier referrals to palliative care for patient and family education on the range of likely clinical outcomes.

METHODS: In February 2015, our study team trained bedside trauma nurses to implement a validated frailty screening process on all patients at least 65 years of age or older who were admitted to the TICU and stepdown unit. Between March and May 2015, the number of older adults admitted, mechanism of injury, numbers of patients screened, and positive screens, along with volume of palliative care referrals, were tracked.

RESULTS: During the three-month period, the mean age of all older admissions (N = 131) was 75.5, of which 49% were screened. Among the patients screened, 38% screened positive for frailty, 45% screened positive for possible dementia, and 23% screened positive for both conditions. Palliative care consultations for older adults increased from 13% (before study) to 33% during the study period.

CONCLUSION: A screening process designed for older adults to assess both physical frailty and cognitive impairment can be standardized into the routine care of older adults admitted to a busy trauma service. Positive screens can serve as a trigger for earlier palliative care assessments, with opportunities for educating patients and their families on the range of clinical trajectories that these vulnerable patients face.