S. Kim1, H. Lesch1, K. Nolan1, P. Parikh1, J. Bruun1 1Wright State University, Department Of Surgery, Boonshoft School Of Medicine, Dayton, OH, USA
Introduction: Geriatric trauma patients often present with complex medical needs and higher risks for complications, making the efficiency and accuracy of their treatment plans crucial. Developing and implementing appropriate standardized order sets (SOSs) for this population is therefore essential. However, non-technical factors, including logistical, institutional, and professional barriers, can affect the integration of SOSs into standard patient care practices. This study aimed to evaluate the impact of standardized order set implementation on providers' usability and perception in treating geriatric trauma patients in high-pressure, emergency settings at a Level 1 trauma center.
Methods: An order set for managing geriatric trauma patients was developed based on current literature and past practices and implemented in December 2022. An IRB-approved Qualtrics survey was distributed to providers (residents, attending surgeons, nursing staff) at our Level 1 trauma center between May and June 2024. The survey included questions on the order set's characteristics, perceived benefits, challenges, and suggestions for improvement. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically.
Results: Of 53 recorded surveys received through Qualtrics, of which 49 were completed and so included in this report. The 49 respondents were composed of residents/fellows (25/49; [51%]), attending general surgeons (15/49; [31%]), and nursing staff, including APP/NP (9/49; [18%]). Of those who responded to the survey, 61% (30/49) had used the new geriatric order set; 13/49 (26.5%) were unaware of the new geriatric order set, and 6/36 (16.7%) were aware of the order set but had not used it. Of those who used the order set, (26/29; [90%]) found it to be easy to use. The order set was utilized 504 times from January 2022 to June 2024. A total of 4260 individual orders were completed.
The qualitative data highlighted primary benefits such as improved patient care and safety measures, including the use of fall mats, maintenance of proper sleep/wake cycles, and reduced polypharmacy. Additionally, respondents noted enhanced staff communication and performance, with fewer incidences of delirium due to increased adherence to delirium prevention protocols and earlier communication about patient status changes. Suggestions for improving the order set included adding more reminders and pop-ups to encourage appropriate use for at-risk patients, providing additional education and reminders about the newly implemented geriatric order set, and increasing staff awareness.
Conclusion: The results demonstrate the potential of standardized order sets to enhance care quality for geriatric trauma patients. Addressing barriers such as lack of awareness and training is essential for optimizing their benefits. Future research should explore the long-term impact on patient outcomes and strategies to improve order set adoption in clinical practice.