SAN ANTONIO — Automatically bumping elderly level 2 trauma patients to level 1 status reduced mortality and emergency department lengths of stay at Indiana University Health Methodist Hospital in Indianapolis. Like trauma services elsewhere, the Methodist team is trying to figure out how best to handle the coming increase in elderly patients as the Baby Boom generation ages. It’s already known that older trauma patients tend to be undertriaged. To improve the situation, “we need to respond quickly with a lot of resources up front so we don’t delay diagnosis” and treatment, said investigator Peter Hammer, MD, assistant professor of surgery at Indiana University. The solution Methodist has tried since October 2013 is a level 1 response to any patient 70 years or older who meets level 2 criteria, regardless of vital sign stability or injury mechanism. With level 1, trauma attendings, residents, respiratory therapists, clinical pharmacists, and others are at the bedside within 15 minutes and CT services and operating rooms are on standby, among other measures. Compared with the 1,271 patients 70 years or older treated in the almost 2 years before the change, the 998 treated in the year and a half afterward were — after controlling for age, comorbidities, and injury severity scores (ISS) — more likely to leave the ED in less than 2 hours (OR, 1.614; 95% CI, 1.088–2.394) and less likely to die (OR, 0.689, 95% CI, 0.484–0.979). The before and after groups were similar, with a mean age of 81 years, a mean ISS of 12.2, a high comorbidity burden, and, for most, a blunt injury: 8.3% died in the before group, vs. 7.6% in the after group. The shorter ED stays occurred despite a nursing staff reduction in 2014. Patients who went into cardiac arrest before arrival or who died in the ED were excluded from the analysis. “A simple, focused intervention of a higher level of trauma activation can decrease ED length of stay and in-hospital mortality in elderly trauma patients,” Dr. Hammer said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma (EAST). Trauma centers are gearing up for aging Baby Boomers by using age as a criteria for higher activation and following recent guidelines from EAST that recommend a lower threshold for trauma activation for patients 65 years or older, among other initiatives. With more expertise and resources, it’s not surprising that level 1 patients left the ED sooner, but it’s unclear what role that played in reducing mortality. “I wouldn’t hazard [to say] that shorter lengths of stay necessarily” saved lives, Dr. Hammer said. Before the intervention, just 4.8% of geriatric patients left the ED within 2 hours, vs. 6.5% afterward. The numbers are low because, “as in most hospitals, there are more trauma patients than beds. [Reducing ED] length or stay [remains] an ongoing project” at Methodist, and not just for the elderly. “The ED is always overcrowded come afternoon and into the evening,” Dr. Hammer said. That’s one of the reasons management supported the project. “They like the concept of getting patients moved through quickly. We have a lot of resources in the ED, so there doesn’t seem to be much of a slowdown” with increased level 1 activation. It probably costs more up front, “but the hope is we’ll save money on the back end with lower mortality and shorter ED stays,” he said. M. Alexander Otto is with the Seattle bureau of Frontline Medical News.