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

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.