Date Available

4-16-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Karen Butler

Committee Member

Dr. Benjamin Hughes

Faculty

Dr. Jill Clemmons

Abstract

Abstract

Background: Traumatic injuries in the geriatric (> 65) patient population can have devastating effects. Only a small percentage of these patients return to independent ambulation and living. As the population continues to age and life expectancy continues to increase, the incidence of traumatic injuries in geriatric patients will continue to increase. Geriatric friendly hospital wards in several disciplines have been shown to reduce length of stay and improve patient outcomes. However, there has been no research surrounding geriatric trauma wards specifically.

Purpose: The purpose of this quality improvement project was to evaluate the impact of admitting geriatric trauma patients to one unit. The geriatric trauma unit incorporated the tenets of a geriatric friendly hospital environment as identified by the American College of Surgeons (ACS) in the 2023 Geriatric Trauma Best Practice Guidelines.

Methods: As many of the geriatric trauma patients as capacity would allow were co-horted to beds on the 9.200 universal unit at the University of Kentucky (UK) Chandler Hospital during the three- month study period. The care providers underwent training specific to best practices for geriatric trauma care. This unit acquired dedicated mobility equipment for each room, and the nursing staff performed delirium rounds each shift. Data were collected from the UK trauma registry database regarding length of stay, complications, and discharge disposition, and compared to a control group of similar geriatric trauma patients from one year prior, as well as patients that were not co-horted to the geriatric trauma unit during the same period.

Results: Demographic differences were noted between the three groups in the variables of age and incidence of OR. The 2024 intervention group sample population was older than both control groups and had a higher incidence of operative intervention than the 2024 control group. There was no statistically significant difference in length of stay noted between the three groups, although operative intervention and ISS were found to increase length of stay. There was no statistically significant difference found in complications incidence among the three groups. However, incidence of delirium and bedside sitter hours were found to have decreased in the 2024 intervention group. There was a statistically significant difference found in discharge disposition distribution between the three groups. This was likely multi-factorial in nature, and further data analysis should be performed regarding payer source.

Conclusions: This study demonstrated that the successful operationalization of a geriatric trauma unit was possible at an academic medical center. Preliminary findings suggest that delirium and bedside sitter reduction are two of the early impacts of a geriatric friendly environment. Further work will need to be done to fully operationalize a geriatric best practice care pathway and screen for frailty in the future.

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