Optimizing Geriatric Trauma Outcomes: The Role of the Trauma Resource Pit Stop

General Information

Institution Name: Palomar Health

Author Name and Title: Zachary Heinemann MSN, RN, CCRN, TCRN

Name of Case Study: Optimizing Geriatric Trauma Outcomes: The Role of the Trauma Resource Pit Stop

Identification of Local Problem

Geriatric trauma patients who did not meet established trauma activation criteria at Palomar Health Medical Center, were frequently experiencing delays in provider evaluation, trauma nurse involvement, and diagnostic imaging from November 2025 to January 2025. Despite presenting high-risk mechanisms of injury and underlying vulnerabilities such as anticoagulation use or frailty, these patients were often managed alongside lower-acuity emergency department patients. The absence of a standardized process for early identification and prioritization resulted in delayed injury recognition and increased risk to patient safety.

Context of the QI Activity

This quality improvement initiative was conducted within a Level II ACS-verified trauma center emergency department with a high volume of geriatric trauma patients. Pre intervention, patient identification and eligibility logic were inconsistent. High-risk older adults might be labeled as Special Consideration, Trauma Resource, routine ED trauma complaint, or not routed through the trauma workflow at all. Documentation for key timestamps (door to provider, Trauma Nurse Team Lead assessment, CT order/completion/final read, consult request/response) was dispersed across the EHR, radiology, registry, and PI notes, and different systems used non-aligned definitions. Some patients fell below activation criteria and were not consistently abstracted into the trauma registry unless they later met inclusion criteria. As a result, the baseline is best characterized as a documented system gap in consistent patient capture and timestamp reliability, rather than a clean retrospective dataset suitable for direct statistical comparison. Functionally, high risk geriatric patients were often managed alongside lower acuity ED patients, with delayed injury recognition and avoidable safety. The project was supported by Trauma Services leadership and integrated into existing trauma performance improvement (PIPS) and emergency department operations.

Interventions

The implementation included workflow finalization, staff education, role clarification, and formal rollout of the Trauma Resource Pit Stop process. A Trauma Resource Pit Stop process was developed and implemented in February 2025. Patients meeting predefined high-risk criteria were identified at triage or prehospital and immediately evaluated by a Trauma Nurse Team Lead (TNTL). Key intervention components included:

• Rapid patient undressing and placement in a gown
• Expedited provider assessment
• Early prioritization for imaging studies
• Transport to imaging facilitated by TNTL or ED technician

This streamlined workflow ensured timely assessment and diagnostic imaging, reducing delays in injury detection and improving coordination of care for high-risk geriatric trauma patients.

Costs and Funding Sources

The intervention leveraged existing personnel and departmental resources and did not require additional capital investment. Process changes were operational in nature, utilizing current staffing models and trauma nursing leadership. No external funding sources were required.

Overall Results and Analysis

Following implementation, from March 2025 to May 2025, key performance metrics demonstrated improvement, including reduced door-to-provider times, faster CT turnaround times, and decreased time to trauma consultation for admitted patients. Ongoing monitoring through trauma PIPS and quality assurance committees demonstrated improved identification and management of high-risk geriatric trauma patients. The intervention enhanced reliability of care delivery without increasing resource utilization.

Limitations

This initiative was conducted at a single institution and relied on adherence to predefined criteria and staff engagement. Variability in ED volume and staffing may impact reproducibility. Long-term outcome data beyond process measures were not the primary focus of this project.

Lessons Learned

Early identification and prioritization of high-risk geriatric trauma patients can be achieved through standardized workflows without increasing resource burden. The intervention converted an inconsistent, staff-dependent recognition process into a defined workflow with clearer inclusion criteria, standardized roles, expedited imaging expectations, and more reliable prospective identification of eligible patients. Engagement of trauma nursing leadership was critical to success. Embedding the process into routine ED operations and reinforcing expectations through regular performance review supported sustainability. This model is scalable and adaptable to other trauma centers facing similar challenges.