Getting Geriatric Triage Right

Tracy Evans
Tracy Evans

Accurately assessing a patient’s acuity at triage is a key step in treating traumatic injuries in any patient, and it’s especially important for older patients.

Under- or overtriage can directly impact subsequent care, dwell time, length of stay and patient outcomes.

“We all recognize that trauma is a surgical disease that is 100 percent preventable,” said Tracy Evans, trauma program manager at St. Joseph’s University Medical Center in Paterson, New Jersey. “But there are specific differences in geriatric trauma. Older patients are subject to anatomical changes, they are more likely to be taking multiple medications and have deficits in hearing and visual acuity. And older trauma patients fear they may be facing a potential long-term stay in acute care or long-term care that can cause important delays in seeking care and in self-care.”

Evans discussed some of the causes of Undertriage in Geriatric Trauma yesterday as part of the Emergency Nursing 2021 Live Program and explored ways to address the problem.

The confusion begins with the basic definition of “geriatric,” she said. In U.S. practice, the term typically applies to patients older than 55, though some studies use 70 as a cutoff. The American College of Surgeons typically uses 55, but there is no official standard, she added.

“At 57, [it] scares me a bit, but whatever age group we settle on, older patients are in need of very specific care,” Evans said. “And their numbers are growing as the population ages.”

In 2020, 20 percent of the U.S. population was 55 or older, and they accounted for 39 percent of trauma admissions, Evans noted.

In addition to the tremendous variation in physical status between a 55-year-old and a 95-year-old, Evans said ageism is a significant problem in the emergency department. Paramedics and triage nurses might take abbreviated histories on the assumption that older patients are frail, have poor memories or are unable to accurately and concisely respond to questions.

“In triage, we’re in the business of predicting outcomes,” she said. “And if you’re experienced with older patients, you know they have altered pain perception and reporting. That makes accurate prediction that much harder.”

Triage tools, such as ENA’s Emergency Severity Index, are used in almost every hospital in the country to help clinical staff prevent life-threatening and costly mistakes when assessing a patient’s acuity.

“We never want to undertriage any patient at any age,” Evans said. “Overtriage is also real with a huge cost to readiness and elevated provider fatigue. We need to be very accurate in our predictions.”

ACS standards limit undertriage to less than 5 percent of patients and overtriage to less than 25 percent of patients, she added.

A recording of this session is available for on-demand viewing on the EN21 meeting platform through Jan. 31.