Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway
| Autor: | S. Andrew Josephson, Stephanie E. Rogers, Jan Yeager, Sudha Lama, Ralph Gonzales, Catherine Y. Lau, Vanja C. Douglas, Judy Maselli, Charles E. McCulloch, Jessica Chao, Julie Casatta, Rhiannon Croci, Sara C. LaHue, Mark Terrelonge, Brian Holt, John C. Newman |
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| Rok vydání: | 2021 |
| Předmět: |
Comparative Effectiveness Research
medicine.medical_specialty Leadership and Management Clinical Trials and Supportive Activities Clinical Sciences Specialty 030204 cardiovascular system & hematology Assessment and Diagnosis Article Odds 03 medical and health sciences 0302 clinical medicine Clinical Research General & Internal Medicine medicine Care pathway Humans 030212 general & internal medicine Care Planning Retrospective Studies business.industry Health Policy Delirium Retrospective cohort study General Medicine Odds ratio Hospitals Good Health and Well Being Cohort Emergency medicine Fundamentals and skills Patient Safety medicine.symptom business Risk assessment |
| Zdroj: | J Hosp Med Journal of hospital medicine, vol 16, iss 7 |
| ISSN: | 1553-5606 1553-5592 |
| DOI: | 10.12788/jhm.3604 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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