Evaluating delirium outcomes among older adults in the surgical intensive care unit
| Autor: | Juliane Jablonski, Rosemary C. Polomano, Kara J. Pavone, Peggy Compton, Paul Junker, Pamela Z. Cacchione |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Critical Care Surgical intensive care unit 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine behavioral disciplines and activities 03 medical and health sciences 0302 clinical medicine Intensive care mental disorders medicine Humans Prospective Studies Aged Retrospective Studies business.industry Mortality rate Medical record Incidence (epidemiology) Delirium Length of Stay nervous system diseases Intensive Care Units 030228 respiratory system Emergency medicine Observational study medicine.symptom Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Heart & Lung. 49:578-584 |
| ISSN: | 0147-9563 |
| DOI: | 10.1016/j.hrtlng.2020.04.009 |
| Popis: | Delirium is prevalent in hospitalized older adults. Little is known about delirium among older adults admitted to the surgical intensive care unit (SICU).The purpose of this study was to describe the incidence of delirium, length of stay, 30-day readmission and mortality rates experienced by older adults in the SICU before and after a nurse-driven protocol for delirium-informed care.This study employed a retrospective observational cohort design. Consecutive patients 65 years or older admitted to the SICU over six-month periods were compared before (n = 101) and following (n = 172) a nurse-driven protocol for delirium-informed care. Patient-level outcomes included incidence delirium, SICU and hospital length of stay, 30-day readmission and mortality rates. All measures were collected using medical record review.In the pre- and post-intervention cohorts, 37% (37/101) and 33% (56/172) of patients screened positive for delirium, respectively. Following implementation of the delirium-informed care intervention, the number of days where no CAM-ICU assessment was performed significantly decreased (Pre 1.1 ± 1.4; Post 0.45 ± 0.65; p0.001) and the number of negative assessments significantly increased (Pre 2.45 ± 1.66; Post 2.94 ± 1.69; p0.0178), indicating that nurses post-intervention were more consistently assessing for delirium.This study failed to show improvements in patient outcomes (SICU and hospital length of stay, 30-day readmission and mortality rates), before and following a delirium-informed care intervention. However, positive trends in the data suggest that delirium-informed care has the potential to increase rates of assessment and delirium identification, thereby providing the foundation for reducing the consequences of delirium and improve patient-level outcomes. Further better controlled prospective work is needed to validate this intervention. |
| Databáze: | OpenAIRE |
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