A Multifactorial Intervention to Reduce Prevalence of Delirium and Shorten Hospital Length of Stay

Authors

  • Bruce J. Naughton MD,

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • Susan Saltzman ND,

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • Fadi Ramadan MD,

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • Noshi Chadha MD,

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • Roger Priore ScD,

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • Joseph M. Mylotte MD

    1. From the Departments of *MedicineMicrobiology, Divisions of Geriatrics/Gerontology§Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New YorkDepartment of Medicine Division of Geriatrics and Gerontology, Kaleida Health, Buffalo, New YorkDepartment of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York.
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  • This work was supported with funds from the Kaleida Foundation and the Western New York Alzheimer's Disease Assistance Center.

Address correspondence to Bruce J. Naughton, MD, 3 Gates Circle, Buffalo, NY 14209. E-mail: Bnaughto@buffalo.edu

Abstract

Objectives: To improve outcomes for cognitively impaired and delirious older adults.

Design: Pretest, posttest.

Setting: A university-affiliated hospital.

Participants: Physicians and nurses in the emergency department (ED) and on an acute geriatric unit (AGU).

Intervention: Multifactorial and targeted to the processes of care for cognitively impaired and delirious older adults admitted to medicine service from the ED.

Measurements: Prevalence of delirium, admission to AGU, psychotropic medication use, hospital length of stay.

Results: Patient characteristics did not differ between baseline and the two outcome cohorts 4 and 9 months postintervention. Prevalence of delirium was 40.9% at baseline, 22.7% at 4 months (P<.002), and 19.1% at 9 months (P<.001). More delirious patients were admitted to the AGU than to non-AGU units at 4 months (P<.01) and 9 months (P<.01). Postintervention medication use in the hospital differed from baseline. Antidepressant use was greater at 4 months (P<.05). Benzodiazepine and antihistamine use were lower at 9 months (P>.01). Antidepressant and neuroleptic use were higher (P<.02) and antihistamine use was lower (P<.02) at 4 months on the AGU than for the baseline group. Benzodiazepine (P<.01) and antihistamine (P<.05) use were lower at 9 months. Each case of delirium prevented saved a mean of 3.42 hospital days.

Conclusion: A multifactorial intervention designed to reduce delirium in older adults was associated with improved psychotropic medication use, less delirium, and hospital savings.

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