#291 Silver trauma competency clinical audit

<h3>Introduction</h3> The objective of the Silver Trauma Knowledge &amp; Skills Audit was to evaluate the current knowledge and skillset of UHW NCHDs in managing elderly trauma cases, also known as ‘Silver Trauma.’ Given the unique physiological complexities that elderly patients face, the audit aimed to determine the level of understanding, previous training experience, and self-assessed proficiency of healthcare professionals. By doing this, the audit aimed to improve the quality of care given to this vulnerable populations. <h3>Methods</h3> The audit encompassed a survey consisting of 30 knowledge-based scenarios, which were formulated using the HECTOR Manual and current RCEM guidelines. These scenarios were designed to encompass prevalent clinical subjects pertaining to the management of trauma in elderly populations. Additionally, the survey incorporated self-rating scales aimed at evaluating participants’ aptitude in handling elderly trauma cases. <h3>Results</h3> Only 11.1% of respondents had received formal training in the management of elderly trauma, indicating a significant deficiency in formal education. The knowledge assessment revealed varying levels of proficiency across key areas. While most respondents answered some questions correctly, challenges were observed in multiple areas. Specifically, 55.6% of respondents answered questions correctly regarding hypotension in elderly trauma, hypothermia, trauma handover, haemorrhagic shock, antibiotic prophylaxis, and renal trauma. Only 44.4% answered correctly on topics such as pelvic fractures, comorbidities in trauma, and pressure ulcer prevention. Notably, a lack of knowledge was observed in managing chest trauma (0% correct), delirium management, neck injury, and hypoglycaemia in the elderly, where only 33.3% of respondents provided accurate responses. Note the small sample size, which represented only one emergency department, and required validation of the assessment tool by geriatric emergency medicine experts for future audits. In the self-assessment section, 77.8% of respondents felt confident in managing elderly patients with multiple medications (polypharmacy), while 55.6% felt confident in treating fall-related injuries. However, only 33.3% felt adequately prepared to discuss end-of-life care options, highlighting a potential need for further training in this domain. Furthermore, 44.4% expressed confidence in recognizing when further treatment may be futile, suggesting a requirement for additional training in ethical decision-making. While self-assessment offers valuable insight into perceived competencies, it has limitations, including the potential for overestimation of abilities and the absence of objective standards. Therefore, a combination of self-assessment and objective evaluations is recommended for a more comprehensive assessment of clinical competency. <h3>Conclusions</h3> To address the identified gaps, it is recommended that formal training programs focused on elderly trauma management be introduced for emergency medicine professionals. These training programs should emphasize critical areas such as comprehensive geriatric assessment, appropriate use of imaging modalities, pain management strategies, and the management of patients on anticoagulation therapy. Furthermore, simulation-based training could enhance practical skills in managing complex elderly trauma cases. Regular audits should also be conducted to monitor progress and adjust training programs accordingly.