Older trauma management – meeting the needs from the front door.

Aim:

To create a clinical culture of “Think Trauma” with all 65+yr olds presenting following unplanned attendances to the ground from any height for any reason.  A good trauma assessment should be possible regardless of the first contact clinicians admitting specialty or grade. Overall improving initial assessment, management of and reduction in missed injuries in these older trauma patients.

Method:

Formed a senior multispecialty team to identify an educational plan. Based on narrative feedback from other trauma courses, a low-fidelity simulation-led course was created. Aimed at more junior clinicians across the front-door specialities to upskill both trauma and elderly care. Knowledge and confidence feedback was collected pre and post course, followed by PDSA cycles to implement change.

Results

Over a period of 4 years we have run 7 courses regionally (major trauma and trauma units), with 140 candidates across surgical, medical and emergency specialties, encompassing physicians and allied healthcare professionals. Results showed at least a 2-point improvement (on a 5-point scale) from underconfident/neutral in assessing and managing older trauma. Qualitative feedback was collated showing positive benefit from the multispecialty format, appreciation of the differences with older trauma and a lower threshold for considering stealth. Over the last 5 years the incidence of missed major injuries in the older group has reduced within the base hospitals.

Conclusion

Development of this multispecialty course has been demonstrated to improve awareness, confidence and knowledge of the presence and potential severity of trauma in older fallers. In targeting junior clinicians and ensuring a multispecialty faculty and candidate cohort this has improved the culture of working together towards better more comprehensive and cohesive older trauma care. Knowing ≥65 represent the largest major trauma cohort, with the majority presenting outside major trauma units; the next phase of this project would be expanded delivery/learning dissemination across trauma networks.