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A Multi‐Phase Quality Improvement Initiative for the Treatment of Active Delirium in Older Persons
Author(s) -
Friedman Joseph I.,
Li Lihua,
Kirpalani Sapina,
Zhong Xiaobo,
Freeman Robert,
Cheng Yim Tan,
Alfonso Francis L.,
McAlpine George,
Vakil Aditi,
Macon Bernard,
Francaviglia Paul,
Cassara Margherita,
LoPachin Vicki,
Reina Katherine,
Davis Kenneth,
Reich David,
Craven Catherine K.,
Mazumdar Madhu,
Siu Albert L.
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16897
Subject(s) - medicine , delirium , emergency medicine , intervention (counseling) , psychological intervention , intensive care medicine , psychiatry
BACKGROUND/OBJECTIVES The Hospital Elder Life Program emerged 20 years ago as the reference model for delirium prevention in hospitalized older patients. However, implementation has been achieved at only 200 hospitals worldwide over the last 20 years. Among the barriers to implementation for some institutions is an unwillingness of hospital administration to assume the costs associated with implementing programs that service all hospitalized older patients at risk for delirium. Facing such a situation, we implemented a unique and self‐evolving model of care of older hospitalized patients who had already developed delirium. DESIGN Hypothesis testing was carried out using a pretest‐posttest design on program administrative data. SETTING Mount Sinai Hospital, New York, NY, a tertiary‐care teaching facility. PARTICIPANTS A total of 9,214 consecutively admitted older patients to non–intensive care (ICU) inpatient units over a 5.5‐year period, regardless of the suspected presence of delirium or risk status for developing delirium. INTERVENTION A delirium intervention program targeting patients in whom delirium has already developed, with a modified delirium team supported by extensive workflow automation with custom tools in our electronic medical records system. MEASUREMENTS Length of stay (LOS) for delirious and non‐delirious patients on units where this program was piloted. Benzodiazepine, opiate, and antipsychotic use on the same units. RESULTS There was a significant drop in LOS by 1.98 days (95% confidence interval = .24–3.71), a decrease in the average morphine dose equivalents administered from .38 mg to .21 mg per patient hospital day, diazepam dose equivalents from .22 mg to .15 mg per patient hospital day, and quetiapine administered from .17 mg to .14 mg per patient hospital day for delirious patients on the program pilot units. CONCLUSION Elements of our unique active delirium treatment program may provide some direction to other program developers working on improving the care of older hospitalized delirious patients. However, the supporting evidence presented is limited, and a more rigorous prospective study is needed.