What Do Trauma Geriatricians Do, and What Do Our Colleagues Think? A Service Evaluation of a Geriatrician In-Reach Service

Introduction 
Early geriatrician involvement in trauma care supports comprehensive geriatric assessment (CGA) and improves outcomes. National workforce constraints mean this specialist input must be targeted to patients most likely to benefit. We undertook a mixed methods service evaluation of a geriatric medicine in-reach service at a major trauma centre to map clinical activity and obtain multidisciplinary (MDT) feedback.

Methods 
We undertook a retrospective mixed methods evaluation of all patients reviewed by the geriatric in-reach team between March and June 2025. Cases were identified from the National Major Trauma Registry (NMTR) and clinical notes were reviewed.

We also surveyed trauma, surgical, critical care and allied health professionals using Likert scale items and free text questions, which underwent thematic analysis.

Results 
87 patients were identified with a mean age of 81.7 and mean Clinical Frailty Scale (CFS) of 4.6. Common interventions included medication optimisation, comorbidity management, delirium assessment, ceiling of care discussions, and falls assessment with targeted interventions.

27 MDT survey respondents reported high levels of satisfaction with the in-reach service (mean 4.74/5). Benefits were described as holistic care, medication optimisation, delirium identification and management, and strengthened MDT decision making, with added value in ceilings of care discussions. Respondents expressed a desire for improvements in service capacity, including 7 day and out of hours cover.  

Conclusions 
Findings add to the literature supporting embedding geriatricians across trauma care. Our analysis demonstrates the range of core interventions offered in such a service and show that it is highly valued. With calls for more geriatrician input, future work might look at the feasibility of a 7 day service and out of hours cover. More fundamentally, we add to the debate about whether care for frail trauma patients should be geriatrician – rather than surgeon - led.