Implementation and adoption of advanced care planning in the elderly trauma patient

Background Geriatric trauma has high morbidity and mortality, often requiring extensive hospital stays and interventions. The number of geriatric trauma patients is also increasing significantly and accounts for a large proportion of trauma care. Specific geriatric trauma protocols exist to improve care for this complex patient population, who often have various comorbidities, pre-existing medications, and extensive injury within a trauma perspective. These guidelines for geriatric trauma care often suggest early advanced care planning (ACP) discussions and documentation to guide patient and family-centered care. Methods A provincial ACP program was implemented in April of 2012, which has since been used by our level 1 trauma center. We applied a before and after study design to assess the documentation of goals of care in elderly trauma patients following implementation of the standardized provincial ACP tool on April 1, 2012. Results Documentation of ACP in elderly major trauma patients following the implementation of this tool increased significantly from 16 to 35%. Additionally, secondary outcomes demonstrated that many more patients received goals of care documentation within 24 h of admission, and 93% of patients had goals of care documented prior to intensive care unit (ICU) admission. The number of trauma patients that were admitted to the ICU also decreased from 17 to 5%. Conclusion Early advanced care planning is crucial for geriatric trauma patients to improve patient and family-centered care. Here, we have outlined our approach with modest improvements in goals of care documentation for our geriatric population at a level 1 trauma center. We also outline the benefits and drawbacks of this approach and identify the areas for improvement to support improved patient-centered care for the injured geriatric patient. Here, we have provided a framework for others to implement and further develop. Electronic supplementary material The online version of this article (10.1186/s13017-018-0201-6) contains supplementary material, which is available to authorized users.

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PID https://www.doi.org/10.1186/s13017-018-0201-6
PID pmc:PMC6127940
PID pmid:30202429
URL https://doaj.org/toc/1749-7922
URL https://paperity.org/p/155979064/implementation-and-adoption-of-advanced-care-planning-in-the-elderly-trauma-patient
URL https://pubmed.ncbi.nlm.nih.gov/30202429/
URL https://link.springer.com/article/10.1186/s13017-018-0201-6
URL http://link.springer.com/article/10.1186/s13017-018-0201-6
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127940
URL https://wjes.biomedcentral.com/track/pdf/10.1186/s13017-018-0201-6
URL http://link.springer.com/article/10.1186/s13017-018-0201-6/fulltext.html
URL https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0201-6
URL http://dx.doi.org/10.1186/s13017-018-0201-6
URL http://link.springer.com/content/pdf/10.1186/s13017-018-0201-6.pdf
URL https://academic.microsoft.com/#/detail/2891388788
URL http://europepmc.org/articles/PMC6127940
URL https://dx.doi.org/10.1186/s13017-018-0201-6
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Access Right Open Access
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Author K. Verhoeff
Author P. Glen
Author A. Taheri
Author B. Min
Author B. Tsang
Author V. Fawcett
Author S. Widder
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Collected From Europe PubMed Central; PubMed Central; Datacite; UnpayWall; DOAJ-Articles; Crossref; Microsoft Academic Graph
Hosted By Europe PubMed Central; World Journal of Emergency Surgery
Journal World Journal of Emergency Surgery, ,
Publication Date 2018-09-01
Publisher BMC
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Language English
Resource Type Article; UNKNOWN
system:type publication
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Source https://science-innovation-policy.openaire.eu/search/publication?articleId=dedup_wf_001::6b89cb4c7e681b69b427dde2fc5248ae
Author jsonws_user
Last Updated 26 December 2020, 17:46 (CET)
Created 26 December 2020, 17:46 (CET)