Beyond the Bruises: A Multidisciplinary Approach to Standardising Silver Trauma Care Post- Fall

Introduction

The management of silver trauma ( patients aged ≥ 65 with traumatic injuries or low-energy falls such as a fall from standing < 2 metres causing life- threatening injuries, resulting in ISS > 15)  often suffers from delayed recognition, leading to poor pain control, prolonged lengths of stay and functional decline. This QIP aimed to align local emergency department practices with TARN and RCEM guidelines.

Our targets were:

Initial pain assessment within 15 minutes,

Analgesia administration within 30 minutes,

Pain reassessment at 30 minutes after analgesia,

Silver trauma assessment by senior clinicians and documentation within 15 minutes and

Diagnostic imaging (X-ray/ CT) within 90 minutes.

Baseline audit data from 500 patients (October- December 2024) revealed profound gaps: only 10% achieved 15-minute pain assessment, 20% received 30-minute analgesia, 10% had 15-minute senior reviews and 60% met imaging targets, with pain reassessment and documentation rarely performed.

Methods

3 PDSA cycles throughout 2025, reviewing 10-15 patients monthly, were done.

Cycle 1 (Feb- Apr): Presented baseline findings and delivered education sessions to doctors and nurses, including Trauma Lead Nurse, NOF and Trauma Coordinators.

Cycle 2 (May-Jul):  Planned monthly re- audits and designed a Proforma.

Cycle 3 (Aug-Oct): Utilised NOF and Trauma Co-ordinators to support patient flow and finalised implementing the Silver Trauma checklist and proforma.

Results

Comparing baseline results to October 2025, initial pain scoring rose to 91%, timely analgesia to 89%, and post-analgesia reassessment to 70%. Senior assessment and documentation to 88%. Early imaging showed modest gains of 60% to 67%, because of structural constraints.

Conclusion

Standardised Silver Trauma Proforma alongside multidisciplinary education significantly optimises acute pain management, documentation fidelity, and clinical escalation with the marginal gains in imaging timelines, requiring dedicated ED and frailty bed configurations to resolve the key system-level bottlenecks.