Geriatric Patient Protocol

On Admission

• Trauma team to order Geriatrics Inpatient Consult on admission.  Discharge will not be delayed for consult.
• Trauma team to identify Advance Directives, preferences/decision makers
• Trauma team to contact social work, practice management, and discharge planning to evaluate resources needed for caregiving
• Trauma/Burn nursing staff to perform delirium evaluation and prevention – sleep protocol, delirium screen (CAM-ICU) & document
• Trauma team to initiate the Early Mobility Protocol

During Admission

• Communication between Geriatrics and Trauma team
• Geriatrics team to determine the need to continue following the patient transferred from the Trauma/Burn Service to other services
• Daily CAM-ICU screen will be done by Trauma/Burn nursing staff and reviewed by geriatric team.  If very vulnerable on VES-13 score is 7 or greater with severe injury, then consider poor prognosis
• Trauma team to consult PT and OT – evaluate caregiving needs, fall risk, home safety, consider driving rehab

On Discharge Planning

• Trauma team, in collaboration with Geriatrics team to reevaluate the patient’s ability to drive and consider recommending Older Driver Evaluation
• Trauma team, in collaboration with Geriatrics team to consider Geriatric Transitional Care follow-up appointment to provide assistance with meds and reassess caregiving needs as appropriate
• Trauma team and Geriatrics team to review PT/OT documentation of pre-discharge functional status prior to patient discharge
• Trauma team to perform medication reconciliation and nursing will provide clear list of medications to the patient/next of kin in addition to D/C summary, as well as Older Driver Evaluation information, when recommended
• Trauma team physician will plan for PCP follow up – send letter to PCP to include discharge summary, medication reconciliation, recommendations for Older Driver Evaluation, and any other pertinent documentation from hospital admission.  Consider direct contact with PCP office prior to patient discharge to if appropriate

In Trauma Clinic Post-Discharge

• If the patient does not have a PCP or Functional impairment, Inadequate care giving/social support, mobility impairment, falls, unintentional weight loss/failure to thrive, cognitive impairment, urinary incontinence, poly pharmacy or multiple chronic conditions, sensory impairment, fatigue, end of life counseling, or issues with pain management are noted, refer patient to Geriatrics Clinic for further assessment and possible Neuropsychiatric evaluation.  If a patient is noted to have severe psychiatric disease without the above symptoms, refer the patient to psychiatry.  Patients with substance abuse issues without the above symptoms, refer to psychiatry’s substance abuse program
• Follow-up on PT/OT discharge recommendations regarding falls/fracture evaluation & treatment plan, resumption of self-care, baseline functional status and transportation.  Consider additional PT/OT referrals as appropriate

3, 6, and 12 months Post-discharge (telephone calls, from Geriatrics)

• Repeat Vulnerable Elders Survey (VES-13), evaluate living situation and caregiving needs, and review whether patient is self-managing medications and transportation (if the patient is not, identify who is)