Don’t Fail the Frail

Lehigh Valley Hospital (Allentown, Pennsylvania)

CSI Summary

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CSI Presentation

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Project Topic:

Geriatric trauma frailty

Hospital Unit:

Transitional Trauma Unit (TTU)

CSI Participants:

  • Chelsy Bechtold, ADN, RN
  • Lauren Curcio, BSN, RN, GERO-BC

Video Presentation:

View this CSI team's project presentation video to earn CERPs.

Project Goals/Objectives:

  1. Increase the use of frailty screening of geriatric trauma patients on TTU 70%
  2. Decrease length of stay for geriatric trauma patients 0.3 days

Project Outcomes:

  1. Increased frailty screening of geriatric trauma patients on TTU 34%
  2. Decreased length of stay for geriatric trauma patients 3% (0.2 days)
  3. Decreased the number of pressure injuries 38%
  4. These outcomes resulted in an estimated annual fiscal impact of $806,652.

Project Overview:

Our CSI team noticed that our trauma patient population comprises primarily geriatric patients: 50% of trauma admissions are over age 65. The team wanted to better assess frailty in our geriatric patients and identify a means of improving patient care. Our research showed that frailty correlates with increased mortality and adverse outcomes. To improve assessment of our geriatric trauma patients, we implemented a clinical frailty scale to identify those patients at increased risk for adverse outcomes.

We invited staff to a project kickoff where we increased their awareness of frailty and provided educational handouts. We posted our chosen clinical frailty scale around the unit and introduced a process of documenting frailty scores in the electronic health record. Our efforts resulted in a 34% increase in frailty screening of geriatric trauma patients and a decrease in geriatric trauma patients’ length of stay of 3% (0.2 days).

Implementing a new assessment process amid COVID-19 pandemic surges and challenging staffing ratios required significant staff buy-in. We initially received pushback from peers due to these obstacles, but with continuous education and patient success stories, our peers became more receptive.

Our change project was positively received by the geriatric medicine team and led to an increase in overall awareness of frailty on our unit. This growth in frailty awareness generated an increase in geriatric consults and a decrease in pressure injuries, both unintended positive outcomes.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.