Review of Literature: Increasing Triage Rate for Geriatric Patients in a Level 1 Trauma Center

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Review of Literature: Increasing Triage Rate for Geriatric Patients in a Level 1 Trauma Center

It has become a major challenge for emergency departments and trauma systems to manage the constantly increasing number of geriatric patients. Research has established that there are two critical reasons why there is a rise in the number of geriatric patients, and they include the high numbers of the aging population particularly those above 60 years. Besides, the elderly people are prone injuries which, therefore, make them frequent visitors to health facilities 

The problem in geriatric trauma cannot be solved when the triage rate of nurses used for non-geriatric patients is similar to that used for geriatric trauma patients. The implication is that the triage rate by nurses should be increased. It is crucial that the process of triaging geriatric trauma patients is reassessed by all primary care providers. To achieve better services, it is important that the management looks into some of the possible reasons that could lead to undertriage needs. This then needs to be followed with a better strategy aimed at neutralizing the problem.  While incorporating both anatomic and physiological aspects of the elderly, it is better is they are given priority in the triage. The result is that the mortality rates for the elderly should be reduced. Besides, deaths witnessed at level 1 trauma center during admission should also be reduced. This paper will attempt to find out what authors have suggested concerning the problem and care of geriatric patients in level 1 trauma centers.

Article 1: Auerbach, M. (2014). “Care for the elderly trauma patient: Is there a role for geriatric

trauma centers driven by geriatrics protocols.” Retrieved from http://search.proquest.com/docview/1637612233?accountid=458

The article advocates for level 1 trauma centers to develop protocols to act as a guide in geriatric patients care due to the increased geriatric population. The research revealed that specialized geriatric trauma centers where the geriatric team is involved in treatment early improve the health outcome of the patients for longer periods. Besides, the patients seeking assistance from such centers face less complications and longer stay. However, the article reveals that more research as per the age specification when geriatric patients begin accessing these specialized protocols for geriatric trauma is essential. 

Article 2: Carpenter, C. R., & Rosen, P. L. (2016). Trauma in the geriatric patient. Geriatric

Emergencies, 280-303. doi:10.1002/9781118753262.ch20

The article identifies accidents and falls as the major trauma cause in the elderly population. Traumatic injuries also are major death causes registered in the under-triaged geriatric trauma patients due to thoracic fractures and brain damages. For atrial fibrillation, anticoagulation therapy is prescribed for the elderly people. Also, admission is advocated for geriatric patients with more than three serious fractures of the ribs to enable them access respiratory and pain management therapy. Depending on the mechanism of injury, the patients also have chest x-rays and electrocardiogram to provide further imaging of the extent of the injury. The article supports the solution.

Article 3: DeLa'O, C., M., Kashuk, J., Rodriguez, A., Zipf, J., & Dumire, R. D. (2014). The

geriatric trauma institute: Reducing the increasing burden of senior trauma care. The American Journal of Surgery, 208(6), 988-994.

According to the article, trauma centers taking care of geriatric patients should focus on cutting down on the costs incurred by having patients stay in the hospitals for lesser durations. When an all inclusive system is employed, research findings show that the quality of care given to the patients is increased, throughput is improved, and the costs they incur is reduced. Therefore, the article supports the system implementation.

Article 4: Frederickson, T. A., Hackett, R.C., Swegle, J. R., and Sahr, S.M. (2013). The

Cumulative Effect of Multiple Critical Care Protocols on Length of Stay in Trauma Population. Journal of Intensive Care Medicine, 28(1), 58-66.

According to this article, the impact on patient care can be realized when a four patient care protocol that targets only the elderly population is established. The protocols have been known to help initiate practical changes which eventually translates to a reduced length of stay in hospitals for the elderly people. The figure estimates that approximately 32% of the patients leave hospital earlier that was expected. The article has used both qualitative and quantitative analysis to give a suggestion. The article joins in the argument that there is a need to have an improved management to trauma needs by primary healthcare providers.

Article 5: Golcuk, Y., & Ozsarac, M. (2014). The relationship between in-hospital mortality and

preexisting medications in geriatric trauma patients. The American Journal of Emergency Medicine, 32(2), 178–189.

There is a need to evaluate victims of an accident who happen to be also patients with geriatric trauma to establish the score of their trauma levels after the accident. This is the information contained in the article. It has been discovered that medications such as antidepressants usually lead to more problems by causing more deaths. As a result, the article advises that a patient's history be determined especially in geriatric trauma patients.

Article 6: Herscovici, D., and Scaduto, J. M. (2012). Management of High-Energy Foot and

Ankle Injuries in the Geriatric Population. Geriatric. Orthopedic Surgery & Rehabilitation, 3(1), 33-44.

This article explains that there is no difference in the complications in an injured ankle of an elderly person and a young patient. However, geriatric patients are quite susceptible to injuries. The article further suggests that when handling patients with injuries at the ankle, then it is crucial to pay attention to age and not the nature of the injury. In the case of postoperative complications, then both cases must be handled in the same manner. This article has also used both qualitative and quantitative data to emphasize the complications that are usually witnessed in geriatric patients’. I agree with the proposal.

Article 7: Kammerlander, C., Gosch, M., Kammerlander-Knauer, U., Luger, T. J., Blauth, M &

Roth, T. (2011). Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg, 131(10), 1435–1444.

The main aim of the article is to elaborate on early intervention need. According to the article, when trauma centers employ multiple methods of intervention in early stages of geriatric trauma, the result may be better health. The article statistically provides information of the appropriate response reaction during emergencies involving geriatric patients with severe trauma. Qualitative data has also been used to reveal that when on admission in trauma centers, geriatric patients need to have access to higher triage rates. From the information issued in the article, the author supports the remedy proposed.

Article 8: Kunac, A., & Mosenthal, A. C. (2013). Ethics in Geriatric Trauma. Geriatric Trauma

and Critical Care, 375-380. doi:10.1007/978-1-4614-8501-8_37

From the article, the double effect principle is of great importance while considering injured geriatric patient management. For instance, there exists particular ethics in surgical care for the elderly people which are rooted in the Hippocratic Oath. According to the oath, it is important to maintain confidentiality, Non-Maleficence (physicians avoid doing harm in non-beneficial situations), and Beneficence (intent of doing good to the patient) principles of practice. Autonomy is also a vital ethical consideration for the patient to give their word before proceeding with any operation. In the case of an incapacitated patient, a close relative should give consent. According to this article, therefore, the principle of double effect is applicable in surgical cases. The article embraces the solution.

Article 9: Mangram, A. (2013). Innovations in geriatric trauma and resident research education:

Bridging the gap. The American Journal of Surgery, 206(6), 834-839.

     According to the article, the geriatric service also known as G-60 is used to address the strategies for innovative management importance and how vulnerable the various trauma mechanisms feature. Research conducted to show that the technology possesses the ability to manage geriatric trauma and has lead to lower mortality rates for age 65 patients. However, for patients older than 65 years, the system incorporates the use of a geriatric trauma expert to ensure the patient’s health is stabilized. The article embraces the G-60 solution.

Article 10: Maxwell, C., Miller, R. S., Dietrich, M. S., Mion, L. C., & Minnick, A. (2015). The

Aging of America: A comprehensive look at over 25,000 geriatric trauma admissions to United States hospitals. The American Surgeon, 81(6), 630-636.

According to the article, the number of geriatric trauma patients admitted to trauma centers increased consistently. The highest numbers of intracranial injuries, motor-vehicle, related trauma, non-white patients, and males were admitted in level 1 trauma centers. Therefore, level 1 trauma centers cater for the high mortality and de-compensation risk patients. The article advocates for level 1 trauma centers use in such cases and further study to be conducted to find out why some patients opt for non-trauma centers.

Article 11: Murry, J., Truitt, M. S., Mani, U., Nimesh, P., Aramoonie, A., Dunn, E. L. (2014).

Have Echocardiograms Affected Recommended Therapy in Geriatric Trauma Patients? Journal of Trauma Nursing, 21 (4), 150 -152.

The article states that pre-operative essential use in patients with geriatric trauma should be assessed for their main use. The main goal of the research was to establish the reaction of geriatric patients about younger people. It is especially important to determine whether pre-operative cardiac risk should be used as a platform for stratified preoperative cardiac clearance of patients. In research involving three hundred and thirty patients with geriatric trauma, 25% underwent a preoperative echo. Among these patients, 13% had abnormalities identified on echocardiogram with none of the deceased cases witnessed during the period was a result of the echocardiogram. With the operative intervention and longer LOS for the echo patients, it was evident that for acute geriatric trauma patients, echocardiogram produces a very low management change rate thus supporting the proposed solution considerably.

Article 12: Noura, L, MD, Thamer, N., Winocour, S., Deckelbaum, Dan., Banici, L., Paola, F.,

Razek, T., and Khwaja, K. (2011). Severely Injured Geriatric Population: Morbidity, Mortality, and Risk Factors. J Trauma, 71(6), 1908–1914.

The article is based on the need to describe the injuries and mechanism of geriatric patients facing severe injuries and identify factors that pre-dispose the patients to mortality. According to the research, falls ranked as the highest injury causation while hypertension came out as the highest probable comorbid disease. The extent of their effect is quantitatively given as 57% for hypertension and 72.3% for falls. Proper care for geriatric patients should be therefore remitted in level 1 trauma centers. However, to probe deeper into the constantly increasing and important geriatric trauma group, further study is advocated.

Article 13: Shi-Neng, J. L., Kleimeyer, C., Genni, L., Burmeister, E., Kennedy, D., Bell, K.,

Watkins, L., and Cooke, C. (2015). Can Geriatric Hip Fractures is Managed Effectively within a Level 1 Trauma Center. J Orthop Trauma, 29(3), 160–164.

According to the article, level 1 trauma centers can come up with special remedies meant for geriatric patients suffering from hip fractures to assist them to cope with hip fractures. One mode of implementing the strategy is where the centers form a geriatric team and an orthopedics team to cater for the patients with hip fractures. A nurse is acquired to cater for the patients the patients are offered a daily consultation with a specialist. When these remedies are put into place, attending to geriatric hip fracture patients is made easier. However, to facilitate the better health of the patient, the article advocates for process realignment and small alterations in the structure.

Article 14: Sophocles, A., & Sinha, A. C. (2014). Perioperative management of the geriatric

trauma patient. Oxford Textbook of Anaesthesia for the Elderly Patient, 136-140. doi:10.1093/med/9780199604999.003.0017

According to the article, the number of elderly people undergoing surgery has increased due to the combination of sophisticated preoperative monitoring and anesthetic and surgery techniques applied. Prerogative assessment is an essential tool in risk identifications that may lead to complications and offer possible plans that facilitate management and minimization of their occurrence. The article further stipulates the importance of weighing between the intended positive outcomes to the harm level before undertaking any operation on a geriatric trauma patient. Before undertaking the operation, the physician ought to conduct an adequate analysis of the extent to which the treatment to be offered potentially risks to harm the geriatric patient. The solution is recommended by the article for practical use.

Article 15: Tucker, Gail., Clark, N. K., Abraham, I. (2013). Enhancing ED Triage to

Accommodate the Special Needs of Geriatric Patients. Journal of Emergency Nursing, 39(3), 309–314.

According to the article, use of Emergency Severity Index (ESI) as a triage system for non-cardinal patients is effective safety precautions. In acutely affected patients, the triage nurses face normal geriatric signs while the ESI algorithm detects the acceptable danger zone the severe signs should not exceed. Therefore, measurements obtained form the basis for determination of the seriousness of the illness and their emerging complications in elder people. Therefore, the article supports the use of ESI to identify the danger levels of the patient’s illness efficiently and make decisions on specific geriatric triage.