Background Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of post-discharge institutionalization than their non-frail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement (QI) project was to first develop a frailty screening program, and, then, if frail, implement a novel Frailty Pathway to reduce LOS, 30-day readmissions, and loss of independence (LOI). Methods This was a before-after study of a prospective cohort of all geriatric (≥65 years old) patients admitted to the TEGS service from 10/2016-10/2017. All patients were screened for frailty for 3 months (pre-intervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our Frailty Pathway (post-intervention). Non-parametric statistical tests were used to assess significant differences in continuous variables; chi-squared and Fisher’s exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. Results Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following Frailty Pathway implementation, median length of stay for frail patients decreased from 9 to 6 days (p=0.4), readmissions decreased from 36.4% to 10.2% (p=0.04), and loss of independence decreased by 40%, (100% vs 60%; p=0.01). Outcomes for non-frail geriatric patients did not differ between cohorts. Conclusions Screening for frailty followed by implementing a Frailty Pathway decreased LOS, LOI and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients, without negatively affecting outcomes in non-frail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. Level of evidence Level IV Study type Prospective time series study Corresponding author: Joseph Posluszny, MD, Assistant Professor of Surgery, Northwestern University, 676 N Saint Clair, Ste 650, Chicago, IL 60611. P: 312-695-4835. F: 312-695-3644. Joseph.Posluszny@nm.org Presented at the 31st Eastern Association for the Surgery of Trauma Annual Meeting, January 9-13, 2018 in Lake Buena Vista, Florida Disclosures: None Funding: This work is funded in part by the Academy for Quality and Safety Improvement (AQSI) at Northwestern University. © 2018 Lippincott Williams & Wilkins, Inc.
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Abstract Objectives Emergency departments (EDs) commonly analyze cases of patients returning within 72 hours of initial ED discharge as...
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