A Multifactorial Intervention Program Reduces the Duration of Delirium, Length of Hospitalization, and Mortality in Delirious Patients

Abstract

Objectives: To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients. Design: Prospective intervention study. Setting: Department of General Internal Medicine, Sundsvall Hospital, Sweden. Participants: Four hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward. Intervention: The intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver‐patient interaction. Reorganization from a task‐allocation care system to a patient‐allocation system with individualized care. Measurements: The patients were assessed using the Organic Brain Syndrome Scale and the Mini‐Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , criteria. Results: Delirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P =.001). The mean length of hospital stay±standard deviation was significantly lower on the intervention ward then on the control ward (9.4±8.2 vs 13.4±12.3 days, P< .001) especially for the delirious patients (10.8±8.3 vs 20.5±17.2 days, P< .001). Two delirious patients in the intervention ward and nine in the control ward died during hospitalization ( P =.03). Conclusion: This study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.