Using the Palliative Performance Scale as a Trigger to Increase Goals-of-Care Conversations in Elderly Trauma Patients (F425B)

Abstract

1.Discuss the utility of using the Palliative Performance Scale to increase goals of care conversations in elderly trauma patients.2.Discuss how a low palliative performance scale can be used to increase goals of care conversations. The Trauma Quality Improvement Program (TQIP) guidelines recommend all trauma patients receive palliative care assessment within 24 hours of admission. Those identified with a life-threatening or disabling injury, severe co-morbidities or frailty should have goals of care conversation (GOCC) within 72 hours. We previously showed that pre-injury Palliative Performance Scale (PPS) <80 predicts long-term mortality and poor function in older trauma patients. We hypothesized that PPS <80 would be an excellent trigger for GOCC, to improve quality of care for older trauma patients. Increase GOCC for older trauma patients. Our quality improvement plan for patients >55 years included a standard pathway with PPS assessment and documentation. PPS <80 triggered a GOCC by trauma or palliative care team. Additional GOCC/palliative care consults for patients with high PPS were at the discretion of the trauma team. After 6 months, we analyzed the rate and timing of GOCC stratified by Glasgow Outcome Scale Extended (GOSE) and compared to baseline cohort. During the 6-month period 147/172 (85%) of the cohort had a documented PPS; 42 (24%) had PPS <80. Of these 39/42 (93%) had a GOCC, compared to 38% at baseline. Eleven patients died, 91% had GOCC. Almost one half (48%) of cohort were discharged alive with a poor functional outcome (GOSE 2-4), and 56% had a GOCC. Compared to baseline, this represents a 25% increase. There was no change in timing of GOCC, 55% vs 65% occurred within 72 hours of admission. PPS <80 is a feasible and effective trigger for GOCC in older trauma patients, especially for those with poor functional outcomes. This quick screening tool is easily learned and can be integrated into routine trauma care to improve palliative care.