Post-acute Considerations in Disposition

  • Laura Harmon
  • Leah Kohri
  • Rosemary Kozar


Geriatric trauma patients are a unique population requiring the balance of treating traumatic injury with the treatment of multiple underlying diseases and variable physiologic reserve. Successful disposition is dependent on early triage, multidisciplinary approach, and prevention of readmission. Early identification of long-term needs is the first step. A multidisciplinary team including physicians, nursing, physical therapy, speech pathology, respiratory care, social services, and case management should all contribute to successful placement. Unplanned readmission is approximately 25% within one year. Early and frequent follow-up to help prevent readmissions is essential with both the trauma team and primary care physicians. Finally, and perhaps most important is helping the patient and family to understand the transition of care and realistic goals to regaining independence.

The adage, “discharge planning begins on the day of admission,” is particularly true for the geriatric trauma patient. A successful approach to geriatric disposition is dependent on: (1) triaging patients for disposition, (2) a multidisciplinary team approach, and (3) preventing readmissions.


Post discharge disposition Discharge planning Multidisciplinary team approach Preventing readmissions 


  1. 1.
    Aitken LM, Burmeister E, Lang J, Chaboyer W, Richmond TS. Characteristics and outcomes of injured older adults after hospital admission. J Am Geriatric Soc. 2010;58(3):442–9.CrossRefGoogle Scholar
  2. 2.
    Botwinick I, Johnson J, Safadjou S, Cohen-Levy W, Reddy SH, McNelis J, Teperman SH, Stone ME. Geriatric nursing home falls: A single institution cross-sectional study. Arch Gerontol Geriatr. 2016;63:42–8.CrossRefGoogle Scholar
  3. 3.
    Claridge JA, Leukhardt WH, Golob JF, McCoy AM, Malangoni MA. Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death. J Am Coll Surg. 2010;210(5):788–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA. 2011;305(10):1001–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Richmond TS, Kauder D, Strumpf N, Meredith T. Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriatr Soc. 2002;50:215–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Beaulieu RA, McCarthy MC, Markert RJ, Parikh PJ, Ekeh AP, Parikh PP. Predictive factors and models for trauma patient disposition. J Surg Res. 2014;190(1):264–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Mori S, Takeda RJ, Carrara FS, Cohrs CR, Zanei SS, Whitaker IY. Incidence and factors related to delirium in an intensive care unit. Rev Esc Enferm USP. 2016;50(4):587–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Alvarez EA, Garrido MA, Tobar EA, Prieto SA, Vergara SO, Briceno CA, Gonzalez FJ. Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. J Crit Care. 2016;37:85–90.CrossRefPubMedGoogle Scholar
  9. 9.
    Ayoung-Chee P, McIntyre L, Ebel BE, Mack CD, McCormick W, Maier RV. Long-term outcomes of ground-level falls in the elderly. J Trauma Acute Care Surg. 2014;76(2):498–503.CrossRefPubMedGoogle Scholar
  10. 10.
    Yeh DD, Fuentes E, Quraishi SA, Cropano C, Kaafarani H, Lee J, King DR, DeMoya M, Fagenholz P, Butler K, Chang Y, Velmahos G. Adequate nutrition may get you home: Effect of caloric/protein deficits on the discharge destination of critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2016;40(1):37–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Fox MT, Persaud M, Maimets I, Brooks D, O'Brien K, Tregunno D. Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis. BMJ Geriatric. 2013 Jul 6;13:70.CrossRefGoogle Scholar
  12. 12.
    Agency for Healthcare Research and Quality. Heart disease, cancer and trauma-related disorders among the most costly conditions for men. Res Activities. 2011; 376.Google Scholar
  13. 13.
    Fawcett V, Flynn-O’brian KT, Shorter Z, Davidson GH, Bulger E, Rivara FP, Arbabi S. Risk factors for unplanned readmissions in older adult trauma patients in Washington State: a competing risk analysis. J Am Coll Surg. 2015;220(3):330–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Fallon WF, Rader E, Zyzanski S, et al. Geriatric outcomes are improved by a geriatric trauma consultation service. J Trauma. 2006;61(5):1040–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Mangram AJ, Mitchell CD, Shifflette VK, et al. Geriatric trauma service: a one-year experience. J Trauma Acute Care Surg. 2012;72(1):119–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Lenartowicz M, Parkovnick M, McFarlan A, et al. An evaluation of a proactive geriatric trauma consultation service. Ann Surg. 2012;256:1098–101.CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
    Soberg HL, Bautz-Holter E, Roise O, Finset A. Long-term multidimensional duration consequences of severe multiple injuries two years after trauma: A prospective longitudinal cohort study. J Trauma. 2007;62(2):461–70.CrossRefPubMedGoogle Scholar
  19. 19.
    Hardin SR. Engaging families to participate in care of older critical care patients. Critical Care Nurse. 2012;32(3):35–40.CrossRefPubMedGoogle Scholar
  20. 20.
    McKevitt EC, Calvert E, Ng A, Simons RK, Kirkpatrick AW, Appleton L, Brown RG. Geriatric trauma: resource use and patient outcome. Can J Surg. 2003;46(3):211–5.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Multitrauma Critical CareR Adams Cowley Shock Trauma CenterBaltimoreUSA

Personalised recommendations