Premium
Outcomes Following Implementation of a Hospital‐Wide, Multicomponent Delirium Care Pathway
Author(s) -
LaHue Sara C,
Maselli Judy,
Rogers Stephanie,
Casatta Julie,
Chao Jessica,
Croci Rhian,
Gonzales Ralph,
Holt Brian,
Josephson S Andrew,
Lama Sudha,
Lau Catherine,
McCulloch Charles,
Newman John C,
Terrelonge Mark,
Yeager Jan,
Douglas Vanja C
Publication year - 2021
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3604
Subject(s) - medicine , delirium , hospital medicine , odds ratio , specialty , emergency medicine , retrospective cohort study , odds , psychological intervention , intensive care medicine , logistic regression , family medicine , psychiatry
BACKGROUND Delirium is associated with poor clinical outcomes that could be improved with targeted interventions. OBJECTIVE To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30‐day hospital readmission, and rates of safety attendant and restraint use. METHODS This retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology‐oncology, and transplant. The multicomponent delirium care pathway included a nurse‐administered delirium risk assessment at admission, nurse‐administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30‐day hospital readmission, and rates of safety attendant and restraint use. RESULTS Adjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96‐0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83‐0.99; P = .028). For all units combined, adjusted odds of 30‐day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80‐0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89‐0.96; P = .0002). CONCLUSION This multicomponent hospital‐wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30‐day readmission decreased throughout the entire cohort.