Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway.
Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway.
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DOI：
10.12788/jhm.3604
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发表时间：
2021-07
影响因子：
2.6
通讯作者：
Douglas, Vanja C
中科院分区：
文献类型：
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作者：
LaHue, Sara C;Maselli, Judy;Rogers, Stephanie;Casatta, Julie;Chao, Jessica;Croci, Rhiannon;Gonzales, Ralph;Holt, Brian;Josephson, S Andrew;Lama, Sudha;Lau, Catherine;McCulloch, Charles;Newman, John C;Terrelonge, Mark;Yeager, Jan;Douglas, Vanja C
谵妄与不良临床结局相关，可以通过有针对性的干预措施加以改善。确定在7个专科非重症监护病房实施的多组分谵妄护理路径是否与缩短住院时间（LOS）相关。次要目标是减少总直接费用，30天再入院的几率，以及安全护理人员和约束使用率。这项回顾性队列研究纳入了22，708例年龄≥50岁的住院患者（11，018例干预前），包括7个非重症监护病房：神经科学、内科、心脏病学、普外科和专科手术、血液肿瘤学和移植。多组分谵妄护理途径包括入院时护士管理的谵妄风险评估，护士管理的谵妄筛查量表，每一个班次，和多组分谵妄干预。主要研究结果是所有单位合并和单独药物单位的LOS。次要结果包括总直接成本、30天再入院几率、安全护理人员和约束使用率。所有单位合并的校正后平均LOS在干预后下降了2%（比例变化，0.98; 95% CI，0.96-0.99; P = 0.0087）。医学单位调整后的LOS下降了9%（比例变化，0.91; 95%CI，0.83-0.99; P = 0.028）。对于所有单位合并，30天再入院的调整比值比下降了14%（比值比[OR]，0.86; 95%CI，0.80-0.93; P = .0002）。药物单位调整成本下降7%（比例变化，0.93; 95%CI，0.89-0.96; P = 0.0002）。这种多组分的全医院范围的谵妄护理路径干预与降低医院LOS相关，特别是对于内科的患者。在整个队列中，30天再入院的几率降低。
Delirium is associated with poor clinical outcomes that could be improved with targeted interventions. 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. 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. 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). 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.