A delirium risk modification program is associated with hospital outcomes

Area of Science:

• Geriatric Medicine
• Quality Improvement Science
• Health Services Research

Background:

• Delirium is linked to adverse health outcomes.
• Delirium risk modification may improve patient and healthcare system results.
• A quality improvement project aimed to assess this impact.

Purpose of the Study:

• To evaluate a quality improvement project for delirium risk identification and modification.
• To determine the association with improved patient outcomes and healthcare system costs.
• To assess the impact on discharge to rehabilitation.

Main Methods:

• Older veterans in a tertiary VA hospital were assessed for delirium risk factors (cognitive impairment, vision impairment, dehydration).
• Risk factors were communicated via electronic medical records, with interventions including cognitive stimulation, sensory improvement, and sleep promotion.
• Outcomes (length of stay, restraint use, discharge to rehabilitation, costs) were compared to a propensity-matched cohort without intervention.

Main Results:

• The intervention group (n=566) showed reduced length of stay (0.7 days shorter) and restraint use (4.0% lower) compared to the control group.
• Discharge to rehabilitation rates were similar between groups.
• Increasing intervention categories correlated with shorter length of stay, lower restraint use, and reduced variable direct costs.

Conclusions:

• Delirium risk identification and modification programs are associated with improved patient outcomes.
• These programs demonstrate potential for reducing healthcare costs.
• Serious consideration should be given to implementing such programs in clinical practice.