Aims
To evaluate the costs and consequences of implementing a comprehensive geriatric assessment-based Traumageriatric Service (TGS) into a large, metropolitan Melbourne hospital.
Methods
A TGS, comprising 0.5 full-time equivalent (FTE) geriatrician, 1.0 FTE advanced physician trainee, 1.0 FTE basic physician trainee was introduced on 6 February 2023, reviewing all patients admitted to the Trauma service over 65 years of age with a Clinical Frailty Scale (CFS) ≥5 and/or delirium. We used routinely-collected health service and Victorian State Trauma Registry data to compare economic costs and consequences associated with people admitted in the 12 months prior to the introduction of TGS (who would have been eligible for the service) to those who were seen 12 months after introduction.
Results
Data were available for 489 people pre-intervention and 463 post-intervention. Patient characteristics were similar prior to and following TGS introduction (median age 85 vs 83 years, 55% vs 54% female, median CFS 5 in both groups). The salary cost of providing TGS over the measurement period was $443,762. The median per-patient revenue was lower after TGS ($15,517) than prior ($18,997, p=0.03). The median per-patient expenses were lower post-TGS ($25,396) than pre-TGS ($32,368, p=0.0003). The average length of acute hospital stay was lower following TGS introduction (11.4 days) than prior (13.6 days, p=0.01).
Conclusions
Patients seen by TGS had lower net financial loss per patient and lower length of stay than those eligible for the service in the year prior to introduction. This suggests a strong business case for continuation and replication.