H. Dhanani1,3, M. Tabata-Kelly1, M. Jarman1,2, Z. Cooper1,2 1Brigham And Women’s Hospital, Center For Surgery And Public Health, Boston, MA, USA 2Brigham And Women’s Hospital, Department Of Surgery, Boston, MA, USA 3Baystate Medical Center, Department Of Surgery, Springfield, MA, USA
Introduction: Despite growing numbers of older trauma patients and national guidelines for geriatric trauma care proposed by the American College of Surgeons (ACS), specialized geriatric trauma care has not achieved widespread adoption or standardization. We sought to understand clinicians’ perspectives on geriatric trauma care, including barriers and facilitators to implementation of geriatric-centered trauma care pathways.
Methods: Trauma and orthopedic surgeons, geriatricians, and trauma program managers (TPMs) at ACS designated trauma centers were recruited via purposive and snowball sampling methods and participated in semi-structured video interviews (from November 2022-August 2023). Interviews queried clinician perspectives regarding 1) existing geriatric-centered trauma care pathways and 2) facilitators and barriers to pathway implementation. Pathways were described as structures and processes using the Donabedian framework. Interviews were qualitatively analyzed until thematic saturation occurred.
Results: Among 24 participants at 19 hospitals in the contiguous United States, 70% practiced at level 1 trauma centers, 50% were female, 46% were trauma surgeons, 13.3% were orthopedic surgeons, 6.6% were geriatricians, and 6.6% were TPMs. Pathway elements differed across hospitals and included structures such as hiring of geriatric clinicians dedicated to the trauma service and creation of physical geriatric wards. Processes included triggered geriatric consults, delirium protocols, injury and age-based criteria for ICU admission, and frailty assessments. Clinicians did not report patient outcomes but highlighted functional need as an outcome missing from current literature. Facilitators of implementation included clinician enthusiasm and satisfaction with team-based care, administrative interest, and financial resources. Barriers for surgeons and TPMs included lack of geriatrics training, mixed results from age-specific protocols, and limited geriatrics staffing. Barriers for geriatricians included lack of consistent engagement with trauma teams and limited staffing.
Conclusion: Surgeons and geriatricians are enthusiastic about team-based geriatric trauma pathways to improve care for older trauma patients, but implementation of such pathways varies substantially. Common barriers to implementation included inadequate training in geriatric care for surgeons, limited availability of geriatricians, and inconsistent evidence for age-specific protocols.